A Case of a 65-year-old woman with Vitiligo and Diabetes Presenting with Severe Autoimmune Hepatitis

Autoimmune hepatitis (AIH) is a chronic liver disease with diverse clinical presentations and significant global variation in prevalence. AIH predominantly affects females and commonly manifests with nonspecific symptoms such as fatigue and malaise, often accompanied by extrahepatic autoimmune disorders. Here, we present the case of a 65-year-old Hispanic woman with vitiligo, type II diabetes mellitus, and severe AIH. Despite extensive diagnostic workup, including serological testing, the cause of this patient’s hepatitis proved to be a challenge. Eventually, autoimmune testing revealed positive anti-smooth muscle antibodies and an elevated IgG, prompting percutaneous liver biopsy, which confirmed mild to moderate active hepatitis with mixed inflammatory infiltrate. Despite there not being a standardized diagnostic criterion for autoimmune hepatitis, the interdisciplinary hospital team agreed that the most likely diagnosis was autoimmune hepatitis, given her constellation of symptoms, serologic testing, and liver biopsy results. Treatment with prednisone was initiated, leading to clinical improvement. This case underscores the importance of a thorough diagnostic workup in suspected AIH cases, especially in patients with concomitant autoimmune conditions, to facilitate timely management and improve patient outcomes. It also highlights the need for a consensus among diagnostic criteria for autoimmune hepatitis.