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Non-alcoholic steatohepatitis or autoimmune hepatitis? Sometimes a closer look under the surface is needed
  1. Georgios N Dalekos1,
  2. Nikolaos K Gatselis1 and
  3. George K Koukoulis2
  1. 1Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Thessaly, Greece
  2. 2Department of Pathology, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece
  1. Correspondence to Professor Georgios N Dalekos; dalekos{at}


Non-alcoholic fatty liver disease (NAFLD) is nowadays the most common liver disease worldwide. Autoimmune hepatitis (AIH) is a relatively rare disease of the liver characterised by female predominance, circulating autoantibodies, polyclonal hypergammaglobulinaemia, interface hepatitis on histology and favourable response to immunosuppression. The possibility of an additional AIH diagnosis in patients with NAFLD (NAFLD/AIH concurrence) or the presence of AIH alone instead of a supposed NAFLD diagnosis represents a challenge for clinicians. We report herein two adult patients (a 33-year-old woman and a 59-year-old man) with a previous NAFLD diagnosis who proved finally to suffer from AIH alone. These two representative cases indicate how difficult and complicated could be sometimes the diagnosis of patients with AIH highlighting the range of disease manifestations and severity while they also underline that although NAFLD is by far the most frequent chronic liver disease this could not be always the case.

  • liver disease
  • nonalcoholic steatosis
  • immunology
  • metabolic disorders

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  • Contributors GND and NKG had the original idea, designed the study and collected and summarised the published literature and the data of the patient. GND wrote the first draft of the manuscript. GND and NKG made the clinical diagnosis, while GKK made the histological diagnosis. GND and GKK made the final critical revision of the manuscript for important intellectual content. All authors have seen and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.