CHSU Discovery

Abstract:
Introduction: Autoimmune hepatitis is a rare autoimmune liver disease characterized by elevated liver enzymes, hypergammaglobulinemia, and autoantibodies. It predominantly affects young to middle-aged women, but can also occur in the elderly population. Here, we present a case of an 85-year-old female with suspected autoimmune hepatitis.

Case Presentation: An 85-year-old female presented with fatigue, jaundice, abdominal pain and elevated liver enzymes. Serologic testing revealed elevated antinuclear antibodies as well as actin IgG antibodies, supporting the diagnosis of autoimmune hepatitis. Due to rapid deterioration and other medical complications, liver biopsy could not be performed. The patient was initiated on steroid therapy. 
Management and Outcome: Despite the inability to confirm the diagnosis with a liver biopsy, the patient showed a remarkable response to steroid therapy, with normalization of liver enzymes within days of treatment initiation. Her hospital course was complicated by respiratory failure from pneumonia as well as bilateral pulmonary effusion and a suspected underlying NSTEMI. Ultimately the patient met her demise despite prompt treatment of her flare of autoimmune hepatitis. 

Discussion: This case underscores the challenges in diagnosing autoimmune hepatitis in elderly patients, especially when invasive procedures like liver biopsy are not feasible. Nevertheless, prompt recognition and initiation of steroid therapy can lead to favorable outcomes, as demonstrated in this case. 

Conclusion: In elderly patients with suspected autoimmune hepatitis, clinical judgment and response to therapy may guide management in the absence of confirmatory diagnostic tests such as liver biopsy. 

Keywords: Autoimmune hepatitis, Elderly, Actin IgG antibodies, Steroid therapy, Diagnostic challenges.