Facing the Challenge of Acute Autoimmune Liver Disease: Report of a Case and Review of the Literature

Autoimmune liver diseases (ALD) comprise two broad cat-egories: those with a hepatic predominance, autoimmune hepati-tis (AIH), and those with a predominance of cholestatic features including primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). An overlap syndrome (OS) is thought to exist where a patient appears with clinical features of more than one immune-mediated liver disease. Based on one personal observation we report a case of histologically proven OS. The relevant literature is briefly reviewed. A 68-year-old male was admitted in our depart-ment with general malaise, anorexia and jaundice. Trans-abdominal ultrasonography as well as computerized tomography showed a slightly enlarged liver with mild fatty deposition and the patient was submitted to transcutaneous liver biopsy. Histological features included inflammatory infiltration of intra-hepatic bile ducts with the presence of endoepithelial lymphocytes and plasma cells, de-generative distortions and even focal damage of relevant epithelial cellular structures, periductal fibrosis, portal inflammation, inter-face hepatitis, ductular proliferation and canalicular cholestasis. It is apparent that exact definitions pertaining the OS are limited and general consensus on the precise determinations of overlap/vari-ant syndromes is warranted in order to enable more accurate future research and establish common guidelines in the management of the condition