Last update:
08-Jul-2004

Overlap syndrome is considered as a subgroup of autoimmune hepatitis with predominant bile duct damage, treated with immunosuppressants without major clinical benefit. The case is reported of a 54-year old female with elevated serum levels of bilirubin, aminotransferases, alkaline phosphatase and γ-glutamyl-transpeptidase. Serum antinuclear antibodies were positive and antimitochondrial antibodies negative. Liver histology showed features of both autoimmune hepatitis and primary biliary cirrhosis. Prednisolone, azathioprine, and ursodeoxycholic acid were administered and the patient had a clinical and biochemical remission. Twelve months after the initiation of treatment the patient has normal liver function tests. In conclusion, this case shows the broad clinical spectrum of the autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, including the presentation of acute icteric hepatitis, which requires appropriate immunosuppressive therapy.

Key words: Acute hepatitis, Autoimmune cholangiitis, Autoimmune hepatitis, Overlap syndrome, Primary biliary cirrhosis.