SHM Converge Scientific Abstract ePoster Gallery-Beyond the Liver: Autoimmune Hepatitis With Unusual Hematologic and Vascular Complications

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This case report describes an 18-year-old male who presented with 2 weeks of fatigue, poor oral intake, jaundice, and dark urine. Initial outpatient testing showed transaminitis and hyperbilirubinemia, but he was lost to follow-up. On admission, he had scleral icterus and marked laboratory abnormalities, including severe eosinophilia, elevated inflammatory markers, very high AST/ALT, cholestatic enzymes, bilirubin, and markedly elevated IgG. Autoimmune markers were positive, including anti-smooth muscle antibody, p-ANCA, and c-ANCA, while evaluation for other liver diseases was negative. EBV IgM was also elevated.<br /><br />Imaging showed hepatosplenomegaly and a non-occlusive thrombus in the left portal vein, raising concern for autoimmune hepatitis complicated by a hypercoagulable state. Upper endoscopy revealed findings consistent with eosinophilic esophagitis. The patient was started on prednisone for suspected autoimmune hepatitis and anticoagulation with heparin, later transitioned to apixaban. He also received pantoprazole.<br /><br />Liver biopsy confirmed autoimmune hepatitis, showing pan-lobular hepatitis with numerous plasma cells, confluent necrosis, canalicular cholestasis, intact bile ducts, and no advanced fibrosis or iron overload. His symptoms, liver tests, reflux symptoms, and eosinophilia improved significantly with treatment. He was later transitioned to azathioprine, and follow-up Doppler ultrasound showed resolution of the portal vein thrombus. At 6 months, he remained asymptomatic and stable off steroids.<br /><br />The report highlights that autoimmune hepatitis can present with unusual hematologic and vascular manifestations, including peripheral eosinophilia and portal vein thrombosis. It emphasizes the importance of recognizing these atypical features, as eosinophil-associated endothelial injury and coagulation activation may contribute to thrombotic complications.

Asset Subtitle

Ayesha Khalid

Meta Tag

Author List Ayesha Khalid, Ayesha Liaqat, Madison , S. Anderson, Tuba Shahid Chaudhry

Category Clinical Vignettes

Concept Autoimmune Hepatitis

Concept Aminotransferase Elevation

Concept Liver Biopsy

Concept Interface Hepatitis

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization Marshall University Joan C. Edward School of Medicine

Presenting Author Ayesha Khalid

Track Pediatric

Keywords

autoimmune hepatitis

portal vein thrombosis

eosinophilia

eosinophilic esophagitis

jaundice

transaminitis

hyperbilirubinemia

azathioprine

prednisone

liver biopsy

Autoimmune Hepatitis

Aminotransferase Elevation

Liver Biopsy

Interface Hepatitis

Corticosteroid