Postpartum Hepatic Decompensation Revealing Type 1 Autoimmune Hepatitis: The Value of Liver Immunological Workup, Especially Anti-F-Actin Antibody Dosing

Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease predominantly affecting women of reproductive age. Pregnancy induces a state of immune tolerance characterized by a shift from pro-inflammatory Th1/Th17 responses to anti-inflammatory Th2/regulatory T cell profiles, often leading to remission of AIH. However, the postpartum period is marked by immune reactivation and a high risk of disease flare, occurring in up to 55% of cases. Diagnosis relies on serological markers, including anti-F-actin antibodies, which are highly specific and correlate with prognosis, alongside liver biopsy for histopathological confirmation. Management during pregnancy requires careful balancing of immunosuppressive therapy to control disease activity while minimizing maternal and fetal risks. Corticosteroids remain the first-line treatment, with azathioprine as a potential adjunct, both generally considered safe in pregnancy with appropriate monitoring. We report the case of a 44-year-old woman who developed AIH type 1 in the early postpartum period, highlighting the diagnostic challenges and therapeutic considerations. This case underscores the importance of vigilant monitoring during pregnancy and postpartum to promptly identify and manage AIH flares, thereby improving maternal and neonatal outcomes.