Diagnosis and Management of Autoimmune Hepatitis After Hepatitis A in a Young Woman

BACKGROUND Hepatitis A (Hep A) is a common cause of viral hepatitis in developing nations. Autoimmune hepatitis is characterized by subacute to chronic liver inflammation, which can lead to liver cirrhosis if untreated. Both conditions remain uncommon in the United States. Development of autoimmune hepatitis following viral Hep A is extremely rare. However, viral infections, including Hep A, have been implicated in triggering autoimmune diseases through immune system activation, molecular mimicry, and inflammatory cytokine surges. Early recognition of this phenomenon is crucial for timely intervention and improved outcomes. CASE REPORT A 32-year-old Hispanic woman with a history of Hep A presented to the emergency room with chief concerns of intermittent epigastric abdominal pain and jaundice for 2 weeks. Physical exam revealed scleral icterus with right upper-quadrant tenderness. Although abdominal imaging was concerning for gallbladder wall thickening, the degree of hyperbilirubinemia (10 mg/dL) and ALT (2100 U/L) elevation were out of proportion to that commonly seen with cholecystitis. The patient's condition deteriorated despite supportive treatment. Further investigations detected IgG against Hep A, positive anti-nuclear antibodies, and anti-smooth muscle antibodies. The liver biopsy confirmed autoimmune hepatitis. The patient showed rapid clinical improvement after initiation of intravenous steroids and was ultimately discharged home. CONCLUSIONS Autoimmune hepatitis developing after acute Hep A is rare. High clinical suspicion and prompt treatment with systemic steroids are key for rapid clinical improvement and preventing complications. Recognizing viral infections as potential autoimmune triggers may help guide earlier diagnosis and intervention.