High-Titre ANA Positivity in NAFLD: An Uncommon Presentation of a Common Disease

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and has emerged as a serious public health challenge. About 20% of NAFLD patients may have low titres (<1:320) of antinuclear antibodies (ANA). However, we describe a patient with NAFLD whose ANA titre was high (>1:320) on presentation. After 3 months of diet, exercise and vitamin E supplementation, the patient was symptomatically better but her ANA titre had increased (>1:640). Her liver biopsy showed features of NAFLD with minimal fibrosis. High-titre ANA (>1:320) positivity is rare. Our patient showed a progressive rise in ANA titre from >1:320 to >1:640 within 3 months even though she was improving and histology showed minimal fibrosis.

Up to 30% of patients with non-alcoholic fatty liver disease (NAFLD) may have antinuclear antibodies (ANA).Low titre (<1:320) ANA positivity is not uncommon, but a high titre is rare.The ANA titre does not correlate with the histological grade of NAFLD.