Autoimmune Hepatitis



Clinical Presentation

 - Highly variable clinical presentation, from subclinical disease to acute liver failure.

 - Symptoms of chronic inflammation (eg fatigue, myalgias/arthralgias) are common.

 - Typically hepatocellular pattern of liver injury, though cholestatic pattern has been reported (eg AIH-PBC Overlap).

 - IgG typically elevated 1.2-3x upper limit of normal.

Diagnosis - If suspected, AIH diagnosis depends on 4 factors:

 - Presence and Titers of Autoantibodies: Auto-Nuclear ANA) & Anti-Smooth Muscle Abs (ASMA) (common, and Anti-LKM & Anti-ALC Abs (rare)

 - IgG Elevation

 - Classic Histologic Findings

 - Exclusion of Other Etiology of Hepatitis (eg Viral)

Management - Strong indications for immunosuppressive tx:

 - ALT + AST > 10x ULN

 - ALT + AST > 5x ULN AND IgG > 2x ULN

 - Certain Histology Findings (eg Bridging Necrosis)

If mild laboratory, clinical, and histologic findings, no great data regarding need for treatment, though therapy is highly individualized to patient.

- Prednisone +/- azathioprine (check TPMT activity before) until response, then gradually taper steroid.



Dr. Bryan Ulrich @BryanCUlrich



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