Autoimmune Hepatitis

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Presentation :

Presentations range from asymptomatic elevation of liver enzymes to fulminant hepatitis.
Common symptoms include fatigue, malaise, jaundice, abdominal pain, and arthralgias.
Features of a liver failure such as ascites, hepatic encephalopathy, and variceal hemorrhage are rare initial presentations.
About 25% of patients with autoimmune hepatitis are asymptomatic.
Physical findings may include hepatomegaly, jaundice, and splenomegaly.

Serologic markers include ANA, SMA, and anti-liver-kidney microsomal type 1 (anti-LKM1).

Induction of remission is typically with prednisone or a combination of prednisone and azathioprine.
Depending on response, maintenance therapy may consist of prednisone or azathioprine monotherapy or combination therapy.
Because of the high rate of relapse, therapy is recommended for at least 2 to 3 years.
Biochemical response may occur within 3 to 8 months of treatment in 85% of patients whose disease responds to standard treatment, but histologic response can lag by several months. Therefore, a liver biopsy is recommended to demonstrate absence of active inflammation before cessation of therapy.