A Case of Autoimmune Hepatitis Chronic Liver Disease with Iron Overload

Abstract

Autoimmune hepatitis (AIH) is a rare autoimmune disorder causing chronic inflammation in liver which affects all ages, both genders, and all ethnicities. It has a heterogenous presentation in which patients may either be asymptomatic, chronically ill or may present with acute liver failure [1]. The diagnosis should be considered in patients with acute or chronic liver dysfunction including patients with graft dysfunction after Liver Transplantation [1]. AIH does not have a signature diagnostic feature, and the diagnosis requires the presence of a constellation of typical features which can vary between patients with the same disease and can occur in other liver diseases. AIH like other inflammatory conditions is associated with increased ferritin levels (acute phase reactant) but normal transferrin saturation level. The presence of excessive ferritin in absence of high transferrin saturation helps differentiate secondary iron overload from hemochromatosis where transferrin saturation is high [2]. There are case reports of chronic liver disease and secondary iron overload. We report a rare case of chronic liver disease due to AIH and secondary iron overload leading to diagnostic dilemma encountered during our clinical practice.