Autoimmune hepatitis mimicking multiple liver infarctions

Autoimmune hepatitis (AIH) is a chronic inflammatory process occurring in the hepatocytes, predominantly affecting females. We report an unusual presentation of AIH in a 28-year-old woman who was admitted with upper abdominal pain, vomiting, and fever for two weeks duration. Her imaging studies revealed multiple lesions in the liver suggestive of liver infarctions. Laboratory investigations revealed anaemia, thrombocytopenia, elevated transaminases, strongly positive ANA titre, and elevated serum immunoglobulin G. Liver biopsy of these lesions demonstrated features of AIH and there was no evidence of infarction. By excluding other causes of hepatitis, a diagnosis of AIH was made. She had a dramatic response to treatment with steroids. This patient highlights the importance of liver biopsy in arriving at a definitive diagnosis.