Unmasking of Autoimmune Hepatitis due to Acute Febrile Illness

Acute liver injury is a common clinical scenario faced by clinicians. The most common infectious agents that cause hepatic injury are the hepatotropic viruses (hepatitis A, B, C, D, and E); however, it is important to recognize other infectious agents that can cause hepatic injury, such as tropical infections like dengue, malaria, enteric fever, and leptospirosis. Another etiology of acute liver injury is autoimmune hepatitis. Infections have been associated with AIH and can serve as a trigger for autoimmunity, thus leading to a gray zone in diagnosis. We report a case of acute liver injury with a diagnostic crossroads between leptospirosis and autoimmunity.