2024 Volume 65 Issue 2 Pages 92-98
A 30-year-old woman without prior abnormal liver function had an increased alanine transaminase level of 30 U/L 5 days after delivering a baby and continued to deteriorate, requiring referral to our department in October. Laboratory findings at first visit were as follows: aspartate transaminase, 96 U/L; alanine transaminase, 137 U/L; immunoglobulin G, 1517 mg/dL; antinuclear antibody, 1: 40; and smooth muscle actin, 1: 160. Liver biopsy revealed mild lymphocytic infiltration in portal areas, minimal interface hepatitis, scattered focal necrosis with plasma cell infiltration, and absence of fibrosis and centrilobular necrosis. Elevated immunoglobulin G level of 2124 mg/dL 2 weeks after the biopsy led to the diagnosis of acute-onset autoimmune hepatitis (AIH). She was started on corticosteroids with gradual tapering in addition to ursodeoxycholic acid and azathioprine, which ultimately preserved normal liver function. Although numerous studies reported AIH resolving during pregnancy with flare-up after delivery, few studies reported new-onset AIH in the postpartum period.
