[Elevated alanine aminotransferase in a four-year-old as an early sign of autoimmune hepatitis].

A four-year-old girl was admitted to a paediatric clinic with a palpable lymph node and elevated alanine aminotransferase (ALT) and weak positive smooth muscle cell antibodies (SMA). Liver biopsy was never done and three months later she was referred with persistent ALT elevation. Eleven years later a dermatologist recognized spider naevi. Autoimmune hepatitis was confirmed by elevation of ALT, immunoglobulin G and positive SMA and a liver biopsy showed cirrhosis and chronic hepatitis. Children with elevated ALT at repeated measurements should be thoroughly examined if no obvious reason is present.