Diagnostic and Therapeutic Challenges in Seronegative Autoimmune Hepatitis With Concurrent Graves Disease and Immune Thrombocytopenia.

Autoimmune hepatitis (AIH) is commonly associated with extrahepatic autoimmune diseases. We discuss the challenges in managing a novel case of seronegative AIH occurring simultaneously with Graves disease and immune thrombocytopenia. Diagnosis was complicated by severe thrombocytopenia delaying liver biopsy and the challenge of managing thyrotoxicosis with antithyroid medications in the setting of acute hepatitis. We were able to safely perform transjugular liver biopsy to confirm AIH, after platelet transfusion. AIH and immune thrombocytopenia were treated with intravenous glucocorticoids, and hyperthyroidism was managed with graded escalation of carbimazole. This case highlights practical strategies for the diagnosis and management of concurrent autoimmune conditions with competing risks.