Autoimmune Hepatitis with Anti Centromere Antibodies

We present the case report of a 49-year-old type 2 diabetes mellitus patient presenting with abdominal pain and black stool for 15 days. A proper workup of laboratory investigations helped us diagnose autoimmune hepatitis with anticentromere antibodies. The authors would like to highlight that screening AIH patients for anticentromere antibody is not mandatory but can be considered, especially in the presence of disease-related symptomatology for quicker, more accurate diagnosis and optimum management. 1. Introduction Autoimmune liver disease is not an uncommon cause of chronic hepatitis in women. Although autoimmune destruction usually occurs without an identifiable trigger, it is generally a progressive hepatitis with increased immunoglobulins and autoantibodies, which primarily responds to immunosuppression. 2. Case Report A 49-year-old lady presented with history of mild, intermittent abdominal pain of 15 days duration associated with passage of black colored stool, nausea, loss of appetite, and generalized weakness. At admission, she was pale, afebrile, with pulse 110/min, blood pressure 150/90？mm？Hg, respiratory rate 26/min, and random plasma glucose 230？mg/dL. There was dyspnea on exertion. Skin was warm with no rash or discoloration. Her abdomen was soft, and bowel sounds were audible. There was a generalized abdominal tenderness with an irregular lump near the epigastrium. The patient was conscious and well oriented with no neurological deficit. She has undergone percutaneous transluminal coronary angioplasty (PTCA) to the right coronary artery 8 years back. The patient had no history of alcohol abuse or received drugs that can idiosyncratically cause hepatitis. Laboratory investigations were as follows (reference ranges in parentheses): hemoglobin 9.1？g% (12–15), PCV 28.2% (36–46), total count 7000/cumm (4000–10,000), RBC 3.27 million/cumm (4.5–5.5), platelet 1.59 lakhs/cumm (1.5–4), total bilirubin 1.8？mg/dL (upto 1), direct bilirubin 0.8？mg/dL (upto 0.3), glycosylated hemoglobin 10.7% (6–8), total protein 5.7？g/dL (6.5–8.1), albumin 2.4？g/dL (3.5–5), alanine transaminase 257 U/L (0–31), aspartate transaminase 224？U/L (0–32), alkaline phosphatase 793？U/L (30–279), gamma glutamyl transferase 477？U/L (1–94), lipase 96？U/L (upto 160), amylase 48？U/L (25–125), lactic dehydrogenase 1203？U/L (266–500), and prothrombin time 18 seconds (control 11.5) INR 1.58. Urea, creatinine, alpha-1 antitrypsin, serum copper, and electrolytes were within reference range. Viral serologies for antibodies to hepatitis B surface antigen, antihepatitis B surface