Autoimmune Hepatitis and Overlap Syndromes

Autoimmune hepatitis (AIH) is an uncommon cause of liver disease caused by immune-mediated destruction of hepatocytes triggered by a variety of agents, including some medications. Typically the triggering event is unknown. There is a broad spectrum of presentations from incidental elevations of liver enzymes (aspartate aminotransferase/alanine aminotransferase) to acute liver failure. AIH is most often confused with drug-induced liver disease. The disease preferentially affects young women. Fortunately most respond well to treatment with corticosteroids though half may have subsequent disease flares. Overlap syndromes exist in which features of both autoimmune hepatitis and cholestatic liver disease are present.