A 40-year-old woman presents with jaundice, pruritus, and fatigue. ANA 1:640, smooth muscle antibody (SMA) positive. Serum IgG 3200 mg/dL. Liver biopsy shows interface hepatitis with rosette formation and plasma cell infiltration. Which treatment is MOST appropriate?

• A Ursodeoxycholic acid (UDCA) monotherapy
• B Mycophenolate mofetil monotherapy
• C Pegylated interferon-alpha plus ribavirin
• D Prednisolone alone or prednisolone + azathioprine ✓

Explanation

Autoimmune hepatitis (AIH Type 1: ANA+, SMA+, elevated IgG, interface hepatitis with plasma cells) is treated with prednisolone (40–60 mg/day) either alone or in combination with azathioprine (to allow steroid sparing). The combination regimen is preferred for long-term use due to fewer steroid side effects. UDCA is the treatment for primary biliary cholangitis (AMA positive, cholestatic pattern). Mycophenolate is a second-line agent for azathioprine-intolerant patients. Interferon is contraindicated in AIH as it can worsen autoimmunity.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.