Autoimmune hepatitis: A case report and literature review

Abstract

Context: Autoimmune hepatitis (AIH) is an uncommon immune-mediated liver disease that leads to hepatocellular damage. The disease may has variable manifestations and severe consequences if left untreated. Early diagnosis made by excluding other etiological factors in targeting autoimmune hepatitis for timely treatment to prevent severe consequences and slow down the disease progression is a critical concern.

Case report: A 84-year-old female patient without histories of using drugs, alcohol, or of viral hepatitis or other chronic diseases, was hospitalized and initially diagnosed with hepatic cirrhosis. Immunological testing showed antinuclear antibodies (ANA) positive, anti-smooth muscle antibody (SMA) negative. The patient was diagnosed, by law of likelihood, with acute severe autoimmune hepatitis, that responded favorably to corticosteroid therapy, and was discharged after 8 days of treatment. One week after discharge from the hospital, the patient quit the prescribed treatment on her own and was hospitalized again with progressive cirrhosis state associated with pneumonia. The patient was treated again with corticosteroids in conjunction with the medications prescribed for her pneumonia.

Conclusion: Autoimmune hepatitis may be presented among elders. In the presence of suggested manifestations, the diagnosis of autoimmune hepatitis should be oriented and considered for rapid institution of treatment (if eligible). From this specific case combined with the 2019 AASLD Guidelines, the author proposes a flexible and less invasive practical diagnostic algorithm for the evaluation of suspected AIH that allows for early diagnosis and more timely treatment in clinical practice.