Autoimmune Hepatitis-Challenging Diagnosis

Abstract

The incidence of Autoimmune Hepatitis (AIH) increases worldwide. If undiagnosed, it may progress end-stage liver disease. Unfortunately, there is no characteristic clinical presentation of this disease, which makes the illness hard to recognize. A case report illustrates the difficulties of diagnosing the patient during his two hospitalizations and his final treatment with prednisolone which improved the patient's condition.

Keywords: AIH; Autoimmune Hepatitis; antibody; immunoglobulin; steroids.

Figure A1

Pictures (A–F) Diagnostic imaging. (A) A polyp in the gallbladder shown in the ultrasound examination of the abdomen. (B) Hepatic steatosis of the liver shown in the ultrasound examination of the abdomen. (C) Enlarged liver shown in the abdominal CT scan with contrast. (D) Hepatic steatosis shown in the abdominal CT scan with contrast. (E) A polyp in the gallbladder shown in the abdominal CT scan with contrast. (F) Homogeneous intraluminal signal of the lumen of the portal vein shown in the abdominal CT scan with contrast.

Figure A2

Pictures (a–g): Histopathological images of the patient’s liver. (a) Hematoxylin and eosin stain: Extensive mixed-cells infiltration bundant mixed-cells infiltration with a predominance of lymphocytes and plasma cells in the portabiliary area, periportal areas and intrahepatic trabecula. (b) Selective stain: paS (+). (c) Selective stain: glycogen (+). (d) Selective stain: Masson’s trichrome (+). (e) Immunohistochemical reaction LCA (+) in the inflammatory infiltrates. (f) Immunohistochemical reaction IgG (+). (g) Immunohistochemical reaction IgM (+).