A rare case of type-I auto-immune hepatitis and thyroiditis presenting with crescentic glomerulonephritis

A middle-aged female patient with a past history of non-alcoholic liver disease and hypothyroidism presented with swelling of the body, off and on, for six months and rapidly worsening renal function. Renal biopsy showed crescentic glomerulonephritis with negative immunofluorescence. Serological tests were positive for anti-thyroglobulin, anti-nuclear antibody (1:80), p-anti-neutrophil cytoplasmic antibodies; gamma globulin was 5.23 g/dL and viral markers were negative. The patient was diagnosed to have autoimmune hepatitis type-1 and treated with injection methylprednisolone pulse (500 mg/day for 3 days) and maintained on oral steroids and azathioprine 100 mg. She responded dramatically to this treatment and has remained in complete remission at last follow-up.