Autoimmune Hepatitis

Autoimmune hepatitis

Autoimmune hepatitis is condition of unknown aetiology which is most commonly seen in young females. Recognised associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3. Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present

Type I	Type II	Type III
Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Affects both adults and children | Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Affects children only | Soluble liver-kidney antigen

Affects adults in middle-age |

Features

may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)
ANA/SMA/LKM1 antibodies, raised IgG levels
liver biopsy: inflammation extending beyond limiting plate 'piecemeal necrosis', bridging necrosis

Management

steroids, other immunosuppressants e.g. azathioprine
liver transplantation