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TL;DR
This case series describes three adolescents with obesity and elevated ALT where initial suspected NAFLD was ruled out by liver biopsy, leading to diagnoses of NASH, AIH+NAFLD, and isolated AIH.
JPGN Reports · 5 authors, 5 centres
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This case series describes three adolescents with obesity and elevated ALT where initial suspected NAFLD was ruled out by liver biopsy, leading to diagnoses of NASH, AIH+NAFLD, and isolated AIH.
All had abdominal ultrasound showing steatosis and positive ANA. Diagnostic liver biopsy was performed for each patient. Patient B's histology showed a plasma cell-rich infiltrate with interface hepatitis and steatosis, confirming concurrent autoimmune hepatitis and NAFLD. Patient C's histology showed a plasma cell-rich infiltrate with interface hepatitis and advanced fibrosis but no steatosis, confirming isolated autoimmune hepatitis. The key implication is that clinicians should not rely solely on obesity or ultrasound to diagnose NAFLD, as autoimmune hepatitis can be present and requires histology for confirmation.