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Autoimmune Hepatitis — RACP Adult Medicine MCQ

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ModerateGastroenterologyAutoimmune HepatitisRACP Adult Medicine

A 35-year-old woman presents with jaundice, markedly elevated transaminases (ALT 1200 U/L), elevated IgG (28 g/L), and positive ANA (1:640) and anti-smooth muscle antibody. Liver biopsy shows interface hepatitis with plasma cell infiltration. What is the most appropriate initial treatment?

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Correct answer: C — Prednisolone plus azathioprine

This is a classic presentation of type 1 autoimmune hepatitis (ANA/SMA positive, elevated IgG, interface hepatitis with plasma cells). Standard induction therapy per EASL 2025 guidelines is prednisolone (0.5–1 mg/kg/day) combined with azathioprine (50 mg/day, uptitrated to 1–2 mg/kg/day). Azathioprine is introduced once bilirubin begins to fall.

Reference: EASL – 2025 – AIH Guidelines; eTG Gastrointestinal 2024