Seronegative Autoimmune Hepatitis Presenting With Concurrent Autoimmune Hemolytic Anemia in a 26-Year-Old Woman: A...

Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disease, and its seronegative variant poses diagnostic challenges due to absent autoantibodies. Autoimmune hemolytic anemia, characterized by immunoglobulin G-mediated erythrocyte destruction, rarely coexists with AIH, creating a complex clinical scenario. We report a 26-year-old woman presenting with jaundice, anemia, and elevated liver enzymes. Serologies for antinuclear antibody, smooth muscle antibody, and anti-liver kidney microsomal type 1 were negative, but immunoglobulin G was elevated. Liver biopsy revealed severe panlobular hepatitis with bridging necrosis, confirming seronegative AIH. Concurrent hemolysis was evidenced by reticulocytosis, low haptoglobin, elevated lactate dehydrogenase, and a positive Coombs test. High-dose corticosteroid therapy led to rapid improvement in hepatic and hematologic parameters within 10 days. This case underscores the importance of considering autoimmune overlap syndromes in young women with jaundice and anemia. Early recognition and immunosuppressive therapy are critical for favorable outcomes.