Diagnostic Approach to Autoimmune Hepatitis

Autoimmune hepatitis (AIH) is a chronic liver disease caused by unknown etiology, characterized by elevated liver enzyme, hypergammaglobulinemia, circulating autoantibodies, and histological interface hepatitis. As untreated AIH often leads to decompensated cirrhosis and even death, prompt and timely diagnosis is essential. However, about 1/3 of patients with AIH have cirrhosis at diagnosis. On the other hand, new onset acute or acute exacerbation of previous undiagnosed AIH can be presented as acute hepatitis. Thus, any patients with acute or chronic liver disease with hypergammagloblinemia without other cause should be considered to evaluate circulating non-organ specific autoantibodies for diagnosis of AIH. In case of suspected AIH, liver biopsy should be considered to evaluate its histological characteristics including interface hepatitis, plasma cell infiltration, emperipolesis, and rosettes. When the diagnosis is made, prompt treatment with prednisolone followed by combined azathioprine should be considered to improve its prognosis.