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Case Reports
. 2025 Jan 24;19(1):34.
doi: 10.1186/s13256-025-05051-2.

An atypical presentation of autoimmune hepatitis with delayed menarche in a Nigerian adolescent: a case report

Promise Udoka Asogwa  1   2 , Bruno Basil  3 , Winifred Njideka Adiri  4 , Nelson Ugwu  1 , Gideon Ekene Anigbo  1   2 , Evaristus Offia  1   2 , Casmir Orjioke  1   2
Affiliations
Case Reports

An atypical presentation of autoimmune hepatitis with delayed menarche in a Nigerian adolescent: a case report

Promise Udoka Asogwa et al. J Med Case Rep. .

Abstract

Background: Autoimmune hepatitis is a chronic liver disease marked by immune-mediated inflammation, necrosis, and the potential to progress to cirrhosis if not treated. This case report presents a rare and atypical presentation of autoimmune hepatitis in a Nigerian adolescent girl, highlighting diagnostic challenges in resource-limited settings. The case is unique owing to the absence of jaundice, a common symptom of liver dysfunction, and features such as delayed menarche and bilateral leg swelling. Case presentation The patient was a 16-year-old Black female patient of Igbo ethnicity from Nigeria, who presented with a 6-month history of bilateral leg swelling and delayed menarche. She had no history of jaundice and abdominal pain, and she had no significant past medical history. She was initially misdiagnosed, delaying appropriate management. Following a comprehensive diagnostic workup, including liver function tests, imaging, and autoantibody testing, which were positive for antinuclear and antismooth muscle antibodies, she was correctly diagnosed with type 1 autoimmune hepatitis. Treatment was initiated with corticosteroids (prednisolone) and azathioprine, which resulted in clinical improvement. However, her serum albumin levels remained low as a result of the preexisting cirrhosis.

Conclusions: This case highlights the diagnostic challenges of autoimmune hepatitis in adolescents, particularly in regions where infectious liver diseases are more commonly suspected. It emphasizes the need for increased awareness and better diagnostic resources to improve early detection and management of autoimmune hepatitis in sub-Saharan Africa. Early intervention with immunosuppressive therapy is essential, even in the absence of classic liver-related symptoms, to prevent progression to advanced liver disease.

Keywords: Autoimmune hepatitis; Case report; Delayed menarche; Liver cirrhosis; Nigeria adolescent.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no conflict of interest.

References

    1. Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D. Chapter 44—Autoimmune hepatitis. In: Gershwin ME, Tsokos GC, Diamond B, editors. The Rose and Mackay textbook of autoimmune diseases (Seventh Edition). Academic Press; 2024. p. 869–904. 10.1016/B978-0-443-23947-2.00074-6.
    1. Lv T, Li M, Zeng N, Zhang J, Li S, Chen S, et al. Systematic review and meta-analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population. J Gastroenterol Hepatol. 2019;34(10):1676–84. 10.1111/jgh.14746. - PubMed
    1. Tunio NA, Mansoor E, Sheriff MZ, Cooper GS, Sclair SN, Cohen SM. Epidemiology of Autoimmune Hepatitis (AIH) in the United States between 2014 and 2019: a population-based national study. J Clin Gastroenterol. 2021;55(10):903–10. 10.1097/MCG.0000000000001449. - PMC - PubMed
    1. Muratori L, Lohse AW, Lenzi M. Diagnosis and management of autoimmune hepatitis. BMJ. 2023;380: e070201. 10.1136/bmj-2022-070201. - PubMed
    1. Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol. 2020;27(1):58–69. 10.3350/cmh.2020.0189. - PMC - PubMed

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