A 38-year-old woman is found to have elevated ALT/AST (5× ULN), total bilirubin 4 mg/dL, and gamma-globulin 4.8 g/dL. ANA titer is 1:640, anti-smooth muscle antibody (ASMA) positive, and IgG 3.2× ULN. Liver biopsy shows interface hepatitis with plasma cell infiltrate. The simplified AIH score (Hennes criteria) gives a score of 7. What does this indicate?
- A Probable autoimmune hepatitis
- B Definite autoimmune hepatitis (AIH) ✓
- C Excludes autoimmune hepatitis
- D Requires additional testing before diagnosis
Correct answer: B. Definite autoimmune hepatitis (AIH)
Explanation
The simplified AIH scoring system (Hennes et al. 2008) uses 4 variables: ANA/ASMA titer, IgG level, liver histology, and absence of viral hepatitis. A score ≥7 indicates definite AIH, while a score of 6 indicates probable AIH. This patient scores: ANA ≥1:80 (2 points) + IgG ≥2× ULN (2 points) + compatible histology (1 point) + ANA/ASMA positive (additional) — totalling ≥7 = definite AIH. Treatment is prednisolone ± azathioprine.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.