Acute vs. Autoimmune Hepatitis: Differentiating the Causes of Elevated Transaminases and Jaundice

Liver inflammation is a common clinical challenge that can have multiple origins, with acute hepatitis and autoimmune hepatitis being two of the most relevant causes. Differentiating between these conditions is crucial for the appropriate management of the patient, as each requires a distinct therapeutic approach. In this article, we will explore the clinical and diagnostic characteristics that allow us to distinguish between these two entities.

Diving into Differential Diagnosis

Acute hepatitis is characterized by rapid liver inflammation, typically caused by viral infections such as hepatitis A, B, C, D, and E viruses, or by exposure to toxins and medications. Typical symptoms include jaundice, fatigue, and elevated transaminases. In contrast, autoimmune hepatitis is a chronic disease mediated by the immune system, where the body attacks its own hepatocytes, presenting with a variety of symptoms that may include chronic fatigue, abdominal pain, and also jaundice.

The diagnosis of autoimmune hepatitis is based on the presence of specific antibodies, such as antinuclear antibodies (ANA) and smooth muscle antibodies (SMA), along with elevated levels of immunoglobulin G (IgG) and typical histological features in liver biopsy. However, the clinical presentation can be similar to that of acute hepatitis, complicating the differential diagnosis. According to a study, liver biopsy is essential to distinguish between these conditions, as it allows for the observation of specific histological features such as centrilobular necrosis in acute hepatitis and interface hepatitis in autoimmune hepatitis [1].

Additionally, it is important to consider the possibility of drug-induced liver injury (DILI), which can mimic both acute and autoimmune hepatitis. Careful evaluation of the clinical history and medication exposure is crucial to avoid misdiagnosis [2].

Conclusions

The differential diagnosis between acute hepatitis and autoimmune hepatitis is a complex process that requires detailed clinical evaluation, serological tests, and, in many cases, a liver biopsy. Accurate identification of the origin of liver inflammation is essential to guide appropriate treatment and improve patient outcomes. Interdisciplinary collaboration and the use of standardized diagnostic criteria are fundamental to addressing this clinical challenge.

Referencias

• [1] Challenges and difficulties in pathological diagnosis of autoimmune hepatitis.
• [2] Case definition and phenotype standardization in drug-induced liver injury.
• [3] Autoimmune hepatitis.
• [4] Acute and chronic hepatitis.

Created 6/1/2025