ABSTRACT
Autoimmune hepatitis has diverse presentations that may mask its identity, affect
its clinical behavior, and confound its management. The objectives of this report
are to characterize the populations that are underdiagnosed or difficult to manage
and to provide guidelines for meeting their challenges. The elderly have an aggressive,
indolent liver disease that responds well to conventional corticosteroid treatment,
but the diagnosis of this disease can be hampered by concurrent illnesses and medication.
Genetic factors affect the expression and outcome of autoimmune hepatitis in different
genders, and they may influence the nature and reactivity to triggering antigens or
hormonal imbalances. Pregnancy can ameliorate autoimmune hepatitis, whereas delivery
can exacerbate it. Asymptomatic patients and those with mild laboratory derangements
may not require immediate therapy, but they commonly require treatment later. Centrilobular
zone 3 necrosis can characterize an acute, severe, or fulminant presentation, and
corticosteroid therapy can be lifesaving if effective within 2 weeks. Region-specific
etiological agents, host-dependent susceptibility factors, and socioeconomic conditions
may diversify the presentation in different ethnic groups. The special clinical challenges
are essential to recognize and treat properly, and they may also extend hypotheses
of pathogenesis.
KEYWORDS
Diagnostic difficulties - treatment recommendations - variant presentations
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Albert J CzajaM.D.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine
200 First Street SW, Rochester, MN 55905
eMail: czaja.albert@mayo.edu
