A case of childhood autoimmune hepatitis of cirrhotic stage manifested by anemia

A 15 years-old boy was pointed out anemia by the medical checkup. Further blood test revealed hepatobiliary enzymes abnormality. Computed tomography showed hepatosplenomegaly. He was diagnosed as autoimmune hepatitis (AIH) based on presence of anti-nuclear antibody and high level of IgG. He was treated with oral prednisolone (PSL: 20 mg/day) administration, and admitted to our hospital for further examination. We performed liver biopsy, and diagnosed as AIH of cirrhotic stage. The improvement of the liver dysfunction was insufficient So he was treated with PSL: 40 mg/day and combined use of azathioprine, however these medications were still ineffective. Then, He was treated with pulsed methylpredonisolone (mPSL) therapy. Liver dysfunction improved after the treatment. This case is the boy who had neither abdominal symptoms nor jaundice and was diagnosed as AIH manifested by anemia Because childhood AIH sometimes diagnosed as advanced stage, accurate diagnosis including liver biopsy and enough immunosuppression therapy is important.