Autoimmune hepatitis: a comprehensive portrait of a silent disease

Introduction: Autoimmune hepatitis (AIH) is a rare chronic liver disease characterized by a variable clinical course and a risk of progression to cirrhosis.The aim of this study was to describe the clinical characteristics, therapeutic management, and outcomes of AIH in our clinical practice. Patients and Methods:We conducted a retrospective, descriptive, singlecenter study covering the period from 2011 to 2024.All patients diagnosed with AIH according to the diagnostic criteria of the International Autoimmune Hepatitis Group were included.Epidemiological, clinical, biochemical, immunological, histological, therapeutic, and follow-up data were collected and analyzed.Results: Twelve patients were included, all of whom were women, with a mean age of 40 years (range: 19-55 years).Clinical presentation was heterogeneous, with asthenia (58.3%), jaundice (41.7%), and pruritus (25%) being the most frequent presenting features.Hepatic overlap syndrome was identified in 66.6% of patients, including overlap with primary biliary cholangitis (PBC) in 87.5% and primary sclerosing cholangitis (PSC) in 12.5%.Cirrhosis was already present at diagnosis in 25% of patients.Associated autoimmune diseases were observed in 83.3% of cases, predominantly connective tissue diseases (50%) and autoimmune thyroid disorders (25%).Biochemically, hepatocellular injury was present in all patients (100%), cholestasis was observed in 66.6%, and polyclonal hypergammaglobulinemia in 58.3%.Immunological assessment showed positive autoantibodies in 66.6% of patients.The most frequently detected autoantibodies were antinuclear antibodies (ANA) (83.3%), anti-smooth muscle antibodies (ASMA) (58.3%), anti-liver kidney microsomal type 1 antibodies (anti-LKM1) (33.3%), and anti-liver cytosol type 1 antibodies (anti-LC1) (16.6%), whereas 33.3% of patients were seronegative.Liver biopsy, performed in 58.3% of patients, predominantly demonstrated inflammatory activity (85.7%), with necrosis in 8.3% and fibrosis in 57% of cases.The 5year overall survival rate was 91.6%.During follow-up, cirrhosis developed in 41.6% of patients, while hepatocellular carcinoma occurred in 8.3%, resulting in death.Conclusion: Autoimmune hepatitis is an uncommon but potentially severe disease.More than one-third of our patients progressed to cirrhosis.Comorbid autoimmune conditions, particularly connective tissue diseases and overlap syndromes with primary biliary cholangitis, were highly prevalent in our cohort, underscoring the importance of early screening and appropriate multidisciplinary management.Early diagnosis, treatment adherence, and long-term follow-up are key determinants of patient prognosis.