Description of a pediatric patients with autoimmune hepatitis in a tertiary care hospital between 2016 and 2023

Abstract

Introduction. Autoimmune hepatitis (AIH) is a chronic liver disease of unknown etiology, characterized by immune-mediated and inflammatory activation. It typically presents with abnormal liver biochemistry, hypergammaglobulinemia, and circulating autoantibodies, with clinical manifestations ranging from asymptomatic presentation to liver failure or complications secondary to cirrhosis. The objective of this study is to present our experience with a case series of pediatric patients diagnosed with autoimmune hepatitis. Methods. We included patients under 15 years of age from a tertiary care hospital in Medellín, Colombia, with a diagnosis of AIH between January 2016 and June 2023. Patients with incomplete data at diagnosis or during follow-up, as well as those with post-liver transplant AIH, were excluded. Clinical and paraclinical variables (laboratory, imaging, and histology) were analyzed. Results were reported descriptively using SPSS version 23. Results. Twenty-one of 33 patients met the inclusion criteria. Thirteen (62%) were female, with a median age at diagnosis of 8.75 years (Q25:5.87 - Q75:11.9). The most common clinical manifestations were jaundice (75%) and hepatosplenomegaly (55%). Extrahepatic autoimmune involvement was observed in 24% of patients. Cirrhosis was identified in 40% by imaging and 47% by biopsy. All patients received corticosteroids and azathioprine as part of their treatment. Median follow-up was
20.8 months (Q25:11.6 - Q75:50.3), during which 9 of the 12 patients (75%) experienced relapse. Conclusions. The clinical features of pediatric patients with AIH in our series were comparable to those reported in national and international literature. However, we observed a higher frequency of cirrhosis at diagnosis and elevated relapse rates during treatment. These findings raise concerns about potential delays in diagnosis and suboptimal treatment adherence, highlighting the need for increased awareness, patient education, and regular follow-up to prevent complications.