Leptospiral infection overlapping with autoimmune hepatitis: A diagnostic conundrum

Autoimmune hepatitis (AIH) is characterised by the presence of circulating auto-antibodies, elevated serum globulin, lymphocytic and plasma cell infiltration on liver biopsy, in the absence of markers of viral hepatitis. Management typically involves use of oral or intravenous corticosteroids in combination with immunosuppressants. We report a rare case of a young patient with a background of AIH that failed to respond to such interventions and was diagnosed to have superadded leptospirosis. In this case report, we describe our challenges in localising the aetiology and management for his acute hepatitis. This report highlights the need to recognise alternative diagnosis in acute hepatitis, especially in AIH patients that fail to respond to conventional management.