Pathology of acute hepatitis phase in autoimmune hepatitis

Abstract

Autoimmune hepatitis (AIH) with acute presentation is classified in acute exacerbation of chronic hepatitis AIH and acute-onset AIH (acute hepatitis phase) without preceding chronic liver disease. The latter, especially, often lacks the clinicopathological features of AIH and its diagnostic criteria has not been established. As a characteristic histology of AIH with acute presentation, centrilobular necrosis (CN) is well-known. However, CN is a feature of drug-induced liver injury (DILI) and histologically distinguishing acute-onset AIH from DILI remains a challenge. In this review, the basic histological findings of AIH showing chronic and acute presentation and the helpful points in the differential diagnosis are described.