Serum testing leads to diagnosis of Type 2 autoimmune hepatitis
Clinical cases: Gastroenterology
Situation
A 19-year-old woman presented with acute hepatitis and jaundice. ALT and AST levels were markedly elevated. IgG was elevated as well. Further examination excluded Wilson disease, obstruction, and viral causes.
Results
ALDG2 test results:
- AMA-M2: <0.1 Negative
- HEp-2 IFA: <1:80 Negative
- SMA screen: Negative
Algorithm branch: Negative first-line results.
Next steps
If all ALDG2 values come back negative, consider LKM, FACT, SLA, PBC2, and/or ANCA testing.
- PBC2/FACT/ANCA/SLA: All Negative
- LKM: 52 U Positive
Working interpretation: Type 2 autoimmune hepatitis (AIH) is favored.
Teaching points
- Negative AMA/HEp-2 IFA/SMA does not exclude autoimmune liver disease when unexplained hepatitis and elevated IgG persist. A diagnosis of Type 2 AIH is favored.
Learn more about our testing for autoimmune liver disease.
