Elevated serum ferritin level is a common finding in iron overload syndrome, autoimmune and viral hepatitis, alcoholic and nonalcoholic fatty liver diseases. High transferrin saturation is not a common finding in above diseases except for iron overload syndrome. We encountered a challenging case of 73-year-old female who presented with yellowish discoloration of skin, dark color urine and dull abdominal pain. Initial laboratory tests reported mild anemia; elevated bilirubin, liver enzymes, and transferrin saturation. We came to the final diagnosis of autoimmune hepatitis after extensive workups. Autoimmune hepatitis is a rare disease, and the diagnosis can be further complicated by a similar presentation of iron overload syndrome. Markedly elevated transferrin saturation can simulate iron overload syndrome, but a liver biopsy can guide physicians to navigate the diagnosis.
Acharya, G. K., Liao, H. I., Frunza-Stefan, S., Patel, R., & Khaing, M. (2017). Autoimmune Hepatitis: Diagnostic Dilemma When It Is Disguised as Iron Overload Syndrome. Journal of Clinical and Experimental Hepatology, 7(3), 269–273. https://doi.org/10.1016/j.jceh.2017.03.006