A case of autoimmune hepatitis in a patient with inflammatory bowel disease and significant lymphadenopathy in the porta hepatis.

The diagnosis of autoimmune hepatitis (AIH) is supported by the presence of elevated transaminases, hypergammaglobulinemia, liver biopsy consistent with AIH, and the presence of AIH autoantibodies. In this case presentation, we highlight the challenges associated with diagnosing AIH in a patient with inflammatory bowel disease (IBD) who presented with elevated transaminases, hypergammaglobulinemia, and without typical autoantibodies. Additionally, on hepatic ultrasound, the patient was found to have hepatic lymphadenopathy concerning for infection or malignancy. Furthermore, the patient's IBD was treated with vedolizumab, which is associated with drug-induced liver injury. They were previously treated with azathioprine, which is associated with malignancy. Ultimately, a liver biopsy was able to confirm the diagnosis of AIH after all other potential causes of elevated transaminases were excluded.