AIH Simplified Criteria — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyAIH Simplified CriteriaRACP Adult Medicine

A 45-year-old woman with suspected autoimmune hepatitis has ANA positive (1:640, homogeneous), anti-smooth muscle antibodies positive, elevated IgG at 28 g/L, and ALT 450 U/L. Liver biopsy shows interface hepatitis with plasma cell infiltrate and hepatocyte rosettes. Using the simplified diagnostic criteria for AIH, what score confirms 'definite' AIH?

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Correct answer: E — ≥7

The simplified diagnostic criteria for autoimmune hepatitis (IAIHG 2008) score points for: ANA or SMA ≥1:40 (1 point), ≥1:80 (2 points); IgG >ULN (1 point), >1.1× ULN (2 points); liver histology compatible (1 point), typical (2 points); and absence of viral hepatitis (2 points). A score ≥7 = definite AIH; 6 = probable AIH. This patient scores: ANA ≥1:80 (2) + elevated IgG >1.1× ULN (2) + typical histology (2) + no viral hepatitis (2) = 8 points (definite AIH). Treatment is prednisolone plus azathioprine induction, transitioning to azathioprine maintenance.

Reference: eTG – 2025 – Gastrointestinal; IAIHG – 2008 – Simplified Diagnostic Criteria; AASLD – 2020 – AIH