{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:00:34Z","timestamp":1785448834793,"version":"3.56.0"},"reference-count":7,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T00:00:00Z","timestamp":1714348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T00:00:00Z","timestamp":1714348800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPGN rep."],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Autoimmune hepatitis (AIH) is relatively rare in children. Herein, our case demonstrates a unique presentation of AIH in a previously healthy 18\u2010year\u2010old female presenting with a mild cough, fatigue, and severe anemia (hemoglobin 2.9\u2009g\/dL).\u00a0Initial evaluation revealed jaundice and scleral icterus, prompting transfer of care and further testing, which demonstrated severe microcytic anemia, pancytopenia, elevated liver enzymes, direct hyperbilirubinemia, and marked splenomegaly. Concern for autoimmune hemolytic anemia resulted in a delayed diagnosis. The combination of triple antibody positivity (anti\u2010nuclear antibodies, anti\u2010actin, and anti\u2010liver\u2010kidney microsomal\u20101) and liver histology findings confirmed the diagnosis of AIH. Intravenous methylprednisolone was initiated to induce remission. Due to pancytopenia and persistently elevated international normalized ratio, tacrolimus was chosen as the maintenance immunosuppression instead of azathioprine. This case highlights several significant considerations for clinicians, including the importance of a timely clinicopathologic diagnosis, the severe anemia presentation secondary to hypersplenism, and the rare finding of triple autoantibody\u2010positive AIH.<\/jats:p>","DOI":"10.1002\/jpr3.12076","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T05:14:38Z","timestamp":1714367678000},"page":"402-406","source":"Crossref","is-referenced-by-count":2,"title":["Autoimmune hepatitis presenting as severe anemia"],"prefix":"10.1002","volume":"5","author":[{"given":"Brandon J.","family":"Calley","sequence":"first","affiliation":[{"name":"Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Polovneff","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Henry","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"North","sequence":"additional","affiliation":[{"name":"Department of Pathology Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Moe","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Pediatric Radiology Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara L.","family":"Mack","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin Milwaukee Wisconsin USA"},{"name":"Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2011.02603.x"},{"key":"e_1_2_8_3_1","volume-title":"StatPearls [Internet]","author":"Shaikh H","year":"2023"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v9.i23.1008"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.296"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26666"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-021-08888-9"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31065"}],"container-title":["JPGN Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpr3.12076","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jpr3.12076","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpr3.12076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T21:23:52Z","timestamp":1785446632000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jpr3.12076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,29]]},"references-count":7,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1002\/jpr3.12076"],"URL":"https:\/\/doi.org\/10.1002\/jpr3.12076","archive":["Portico"],"relation":{},"ISSN":["2691-171X","2691-171X"],"issn-type":[{"value":"2691-171X","type":"print"},{"value":"2691-171X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,29]]}}}