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Autoimmune hepatitis — ESEGH MCQ

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ModerateHepatologyAutoimmune hepatitisESEGH

A 29-year-old woman presents with jaundice, arthralgia and fatigue. Blood tests show ALT 980 IU/L, bilirubin 74 micromol/L, IgG 28 g/L and INR 1.3. Viral hepatitis serology is negative; antinuclear and smooth muscle antibodies are positive. Liver biopsy shows interface hepatitis with plasma cells. What is the most appropriate management?

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Correct answer: C — Prednisolone followed by azathioprine maintenance

Autoimmune hepatitis is supported by the hepatitic enzyme pattern, raised IgG, autoantibodies and interface hepatitis, and standard treatment is corticosteroid induction followed by steroid-sparing azathioprine where tolerated. Antiviral therapy is not indicated with negative viral serology. UDCA treats cholestatic disorders such as PBC rather than active AIH. The pearl is that untreated AIH can progress rapidly even in young adults.

Reference: EASL Autoimmune Hepatitis Guideline 2025; BSG Autoimmune Hepatitis Guidance