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Demonstrates inadequate testing for autoantibodies in autoimmune hepatitis, revealing rarity of true seronegative cases.
Key Points This study by Colapietro et al. [1] demonstrates that the diagnosis of seronegative autoimmune hepatitis is often based on inadequate testing for autoantibodies. The best technique to test for autoantibodies in autoimmune liver disease is indirect immunofluorescence on murine triple tissue. Anti‐soluble liver antigen, an autoantibody highly specific for autoimmune hepatitis, is not detected by immunofluorescence but by immunochemical solid phase assays. When correct testing for autoantibodies is used, seronegative autoimmune hepatitis is very rare. Perinuclear anti‐neutrophil cytoplasmic antibody (pANNA) can be the only autoantibody present at diagnosis in autoimmune hepatitis and should be tested on a neutrophil substrate by immunofluorescence.
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