Breaking the ratio: type I autoimmune hepatitis in a school aged boy

Autoimmune hepatitis in the pediatric population, a relatively rare pathology, that might be overlooked by clinicians, poses an important threat if left untreated. Autoimmune hepatitis type 1 (AIH type 1) is defined by a 4:1 female-to-male ratio, a bimodal age group distribution, and positive serological anti smooth muscle antibodies (anti SMA) and/or anti-nuclear antibodies (ANA). Typically this pathology expects a good clinical outcome with favorable response to corticotherapy. We present the atypical case of a 7-year-old male, with medical history that reveals previous presentation in an infectious disease clinic for similar complaints. Following admission into our clinic, differential diagnosis raised the suspicion of autoimmune hepatitis, possibly induced by an prior exposure to Epstein-Barr virus (EBV) and/or Albendazole usage. With positive serum anti smooth muscle antibodies (anti-SMA), the suspicion of autoimmune hepatitis was confirmed, and targeted treatment was initiated. Our patient presented a favorable clinical outcome, with significant improvement over the course of 16 hospitalization days, even though our patient didn’t have the classical characteristics of AIH type 1. This case presentation aims to underline the need for early etiologic treatment for ensuring a favorable prognosis, and to raise concern over the potential trigger factors of developing autoimmune hepatitis.