%0 Journal Article
%T Autoimmune Hepatitis: Diagnostic Dilemma in the Setting of Suspected Iron Overload
%A In Chul An
%A Ashish K. Tiwari
%A Srujan Ameda
%A Heather S. Laird-Fick
%J Case Reports in Gastrointestinal Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/872987
%X Autoimmune hepatitis (AIH) is an inflammatory condition of the liver that has a multitude of clinical presentations from chronic hepatitis to acute fulminant hepatitis. AIH diagnosis is typically suspected after ruling out other causes of hepatitis (such as vial hepatitis, hemochromatosis, Wilson¡¯s disease, and primary biliary cirrhosis) through serological tests and by findings of high titers of certain autoantibodies (ANA and anti-SMA for type 1 AIH and anti-LKM-1 for type 2 AIH). AIH like most inflammatory conditions is associated with increased ferritin levels (acute-phase reactant) but typically near-normal transferrin saturation. The presence of excessive ferritin level in absence of high-transferrin saturation helps differentiate secondary iron overload from hemochromatosis where transferrin saturation is typically high. We herein describe a case of AIH that presented with high ferritin levels and transferrin saturation suggesting a diagnosis of hemochromatosis and needed arduous work-up to arrive at accurate diagnosis of AIH. 1. Introduction Autoimmune hepatitis (AIH) is an inflammatory condition of the liver that has a multitude of clinical presentations from chronic hepatitis to acute fulminant hepatitis [1, 2]. Typical symptoms are nonspecific and can include fatigue, jaundice, nausea, and abdominal pain. It is a relatively rare disease affecting women more than men (3.6£¿:£¿1 ration) with mean incidence of 1-2 per 100,000 persons per year and prevalence of 11¨C17 per 100,000 persons [1, 2]. The diagnosis is based on histological findings and presence of one or more specific autoantibodies (ANA and anti-SMA for type 1 and anti-LKM-1 for type 2). Other chronic liver diseases that could often have similar presentations include viral hepatitis, primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and hereditary liver disorders such as alpha-1 antitrypsin deficiency, Wilson¡¯s disease, and hemochromatosis. Although serological tests to detect antibodies are useful initial tests, they could be indeterminate and are not very specific. Liver biopsy is usually needed to differentiate AIH from other causes and needs a careful interpretation by expert pathologist to reach a final diagnosis. Inflammatory conditions are often associated with elevated ferritin level because the latter is an acute-phase reactant [4]. In case of liver, elevated ferritin levels are most commonly related to alcohol abuse, chronic viral hepatitis, and nonalcoholic fatty liver disease (NAFLD) [3]. However, serum transferrin saturation in such cases is typically
%U http://www.hindawi.com/journals/crigm/2013/872987/