Autoimmune hepatitis in children

Autoimmune hepatitis (AIH) is an inflammatory disease of the liver, secondary to a loss of immune tolerance against liver antigens resulting in a progressive destruction of the hepatic parenchyma. 1 The article from Porta et al. in the present issue describes the clinical, laboratory, and histologic features of a large cohort of children with AIH, and includes an analysis of the treatment response and outcome. 2 This multicenter study presents the results of a retrospective revision of medical records from 828 children, representing the largest series in the world literature.A main characteristic of AIH is its fluctuant course, partially explaining the delay between the first symptoms or signs and the diagnosis of the disease, delaying the beginning of the immunosuppressive treatment, thus increasing the risk of developing cirrhosis and liver failure. 1 In the present series, the time recorded between onset and diagnosis was 11 and 15 months for AIH type 1 and type 2, respectively.To avoid such delay, AIH should be included in the differential diagnosis of any liver anomaly, from fortuitous discovery of high serum aminotransferases to signs of chronic liver disease, keeping in mind that spontaneous partial improvement