Autoimmune hepatitis: what should be considered when conventional therapies fail?

Autoimmune hepatitis (AIH) is an immune-mediated disease characterised by elevated transaminases, immunoglobulin G and autoantibody positivity. Treatment is based on corticosteroids and azathioprine. Up to 15% of patients will require a second line of treatment, with remission rates after this second line of about 60-75%. There is controversy about what the next step of treatment should be. We present the case of a woman diagnosed with IAH who failed several lines of treatment and had to start treatment with infliximab despite an off-label indication, but with a favorable clinical response.