Autoimmune hepatitis in a young female Nigerian presenting in advanced cirrhosis: A case report

Background: Autoimmune hepatitis is an immune-mediated, chronic inflammation of the liver that can progress to cirrhosis and hepatocellular carcinoma if untreated. It is a rare cause of chronic liver disease in Nigeria. Case Presentation: Our patient is a 32-year-old lady who presented with a nine-year history of intermittent abdominal swelling and recurrent jaundice. There were peripheral stigmata of chronic liver disease. Abdominal CT scan showed hepatomegaly with multiple ill-defined heterogenous lesions and nodular hepatic margins, splenomegaly and ascites. Anti-Nuclear Antibody was positive, and there was hypergammaglobulinaemia. Liver biopsy showed histologic features that were consistent with Autoimmune Hepatitis. Upper gastrointestinal endoscopy revealed columns of grade 3 oesophageal varices, and she had variceal band ligation therapy done. Based on the International AIH Group revised criteria, she had a score of 8, thus fulfilling the criteria for the diagnosis of definite type 1 AIH. She was commenced on tab prednisolone alongside other liver supportive therapies with improvement in her clinical condition and biochemical profile. Conclusion: Autoimmune hepatitis is an uncommon cause of chronic liver disease in Nigeria; a high index of suspicion would enable early diagnosis and prompt treatment with immunosuppressants in order to prevent the development of advanced liver disease.