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Rapid diagnosis and initiation of immunosuppressive treatment are necessary for both acute exacerbation and acute\u2010onset to prevent fatal liver failure. The diagnostic criteria commonly used for classical AIH are generally applicable to acute exacerbation, but acute\u2010onset AIH may present with additional pathological features. These features include an acute hepatitis phase characterized by centrilobular necrosis. However, centrilobular necrosis is also a feature of drug\u2010induced liver injury, and there are no known histological characteristics exclusive to acute\u2010onset AIH. Moreover, the possibilities of drug\u2010induced AIH and immune\u2010mediated drug\u2010induced liver injury make diagnosis even more difficult. At present, liver biopsy is mandatory for the diagnosis of AIH with acute presentation, but careful consideration of all clinicopathological signs is necessary for differential diagnosis.<\/jats:p>","DOI":"10.1111\/hepr.12931","type":"journal-article","created":{"date-parts":[[2017,7,4]],"date-time":"2017-07-04T13:17:39Z","timestamp":1499174259000},"page":"963-971","source":"Crossref","is-referenced-by-count":27,"title":["Challenges and difficulties in pathological diagnosis of autoimmune hepatitis"],"prefix":"10.1111","volume":"47","author":[{"given":"Kenichi","family":"Harada","sequence":"first","affiliation":[{"name":"Department of Human Pathology Kanazawa University Graduate School of Medicine  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Canh","family":"Hiep","sequence":"additional","affiliation":[{"name":"Department of Human Pathology Kanazawa University Graduate School of Medicine  Kanazawa 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