Auto Immune Hepatitis Presenting as Ascites – A Case Report

Auto immune hepatitis is a disorder of unknown etiology characterized by unresolving inflammation of liver, interface hepatitis on histology, hypergammaglobulinemia, and presence of auto antibodies, strong association with other autoimmune diseases. It occurs most often in women, in second and third decades of life, may develop in either sex at any age. We present a case of 40 year old woman presented to our hospital with icterus since one month on examination patient had jaundice, pedal edema and ascites. Investigations revealed highly elevated bilirubin and liver enzymes, serology negative for A,B,C, E with marked IgG elevation. Ultrasound abdomen showed features suggestive of cirrhosis with ascites liver biopsy and analysis of auto antibodies showing high titers suggestive of auto immune hepatitis. Patient started with steroid therapy resulting in improvement of patient condition. Elevated LFT with viral serology negative should always be investigated. Early diagnosis and treatment of autoimmune hepatitis is essential to improve prognosis. A patient of autoimmune hepatitis presenting directly in chronic decompensated cirrhotic state is very rare which happened with our case. Any autoantibody positivity should be carefully considered to avoid misdiagnosis delaying appropriate clinical management.