Postpartum Seronegative Autoimmune Hepatitis: Diagnostic Challenges and Clinical Implications.

Postpartum autoimmune hepatitis (AIH) is a rare but serious condition triggered by immune rebound after delivery. Diagnosis is typically supported by elevated immunoglobulins and positive autoimmune markers; however, seronegative presentations remain diagnostically challenging. We present the fourth reported worldwide case of seronegative postpartum AIH in a 36-year-old woman who developed jaundice, pruritus, pale stools, and dark urine 4 months after delivery. Laboratory evaluation revealed severe hepatocellular injury with aspartate aminotransferase 1373 U/L, alanine aminotransferase 2137 U/L, and marked hyperbilirubinemia. Viral, toxic, metabolic, and rheumatologic investigations were negative, while autoimmune serologies and immunoglobulin levels remained normal. Imaging demonstrated hepatomegaly without biliary obstruction or vascular abnormalities. Liver biopsy revealed acute-on-chronic autoimmune-mediated hepatitis with necrosis, confirming seronegative postpartum AIH. This case emphasizes seronegative AIH as a critical consideration in postpartum acute hepatitis, with liver biopsy essential for diagnosis and early treatment.