Autoimmune hepatitis and immune dysregulation: A case series

To assess the presence of inborn errors of immunity (IEI) in a pediatric autoimmune hepatitis (AIH) cohort. This retrospective study included patients aged 0-18 diagnosed with AIH in our center between 1995 and 2023 and followed by the immunology department for a clinical and/or molecular IEI diagnosis. Among our 83 AIH patients, five (6%) displayed signs of associated IEI. Two of those patients had a genetic confirmation of IEI (SP110 and AIRE homozygous mutations). IEI-related signs were recurrent infections (n=3), immune-mediated cytopenia (n=4) or skin disease (n=2) and autoimmune polyendocrinopathy (n=1). The four patients diagnosed with seronegative AIH responded to immunosuppressive therapy, while the AIH type 2 patient underwent emergent liver transplantation for fulminant liver failure at diagnosis. Our small case series highlights the need to look for signs of immune dysregulation in AIH patients. Conversely, as AIH can be atypical in IEI, the threshold should be low to perform a diagnostic liver biopsy in IEI patients suffering from chronic cytolysis. We believe that systematic genetic testing and immune phenotyping of AIH patients who display signs of immune dysregulation will be crucial to better understand the close link between AIH and IEI.