A 38-year-old woman with autoimmune hepatitis (interface hepatitis, elevated IgG, ANA positive) also has pruritus, elevated ALP 3× ULN, and positive AMA. Liver biopsy shows both interface hepatitis and granulomatous duct destruction. What is the most appropriate initial treatment for this overlap syndrome?
- A UDCA plus prednisolone and azathioprine ✓
- B Prednisolone plus azathioprine
- C Ursodeoxycholic acid 15 mg/kg/day alone
- D Mycophenolate mofetil monotherapy
Correct answer: A. UDCA plus prednisolone and azathioprine
Explanation
The patient meets criteria for AIH-PBC overlap (Paris criteria). Treatment should address both components. Combination of UDCA with immunosuppression (prednisolone and azathioprine) is recommended. UDCA alone would not control the AIH component. Immunotherapy alone may not adequately treat the cholestatic injury. Mycophenolate is second-line for AIH intolerance but does not treat PBC.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.