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 #Autoimmune #Hepatitis #AIH #Diagnosis #Management #Hepatology
