Hepatitis A is an acute viral disease, usually self-limited, with nonspecific symptoms and liver abnormalities. Differential diagnoses include other liver diseases, such as autoimmune hepatitis (AIH). A 38-year-old married female teacher, previously healthy, born and residing in Campo Grande, Mato Grosso do Sul. In August 2024, she developed jaundice, dark urine, epigastric pain, and asthenia, associated with elevated transaminases and preserved liver function, and was diagnosed with hepatitis A by serology. At that time, vigorous hydration and rest with outpatient follow-up were recommended. Four months after diagnosis, the patient continued to show abnormal transaminase levels, with AST and ALT peaks of 3 and 10 times the upper limit of normal, respectively, despite clinical improvement. Further investigation revealed positive antinuclear antibody (ANA) at a titer of 1:160 with fine speckled nuclear pattern; anti–smooth muscle antibody, anti-mitochondrial antibody, and hepatitis B and C serologies were negative; copper and iron profiles were unremarkable. In March 2025, the patient underwent liver biopsy showing chronic hepatitis with moderate interface activity, moderate portal lymphomononuclear inflammatory infiltrate, and a moderate number of portal plasma cells, consistent with autoimmune hepatitis, stage 1 and inflammatory activity grade 2. Prior to treatment initiation, prophylaxis for strongyloidiasis and screening for latent tuberculosis infection were performed. Based on the International Autoimmune Hepatitis Group Diagnostic Score, the patient scored 19 points, confirming the diagnosis of AIH. Treatment with prednisone 1 mg/kg/day was initiated, followed by azathioprine at a dose of 1.5–2 mg/kg/day, with good therapeutic response and normalization of transaminases within two weeks. Acute viral hepatitis may lead to underdiagnosis of AIH, especially hepatitis A, which has nonspecific symptoms. Diagnosis requires clinical, serological, and histological correlation. The presence of autoantibodies, hypergammaglobulinemia, and portal plasma cell infiltration are classic AIH findings. This case highlights the importance of careful clinical and histopathological evaluation, even in patients with a clinical presentation apparently compatible with viral hepatitis, particularly when liver function test abnormalities persist.
Teixeira et al. (Sun,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: