{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:26:39Z","timestamp":1790357199010,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Seronegative autoimmune hepatitis (SnAIH) lacks detectable conventional autoantibodies (ANA, SMA, anti\u2010LKM, anti\u2010LC1, and anti\u2010SLA\/LP), posing diagnostic challenges. Increasing evidence suggests SnAIH in adults reflects limitations in autoantibody detection rather than a distinct variant. We systematically re\u2010evaluated all biopsy\u2010proven SnAIH cases in a large international multicenter AIH cohort using standardized testing. Among 760 patients with baseline liver biopsy, 52 (6.8%) were initially classified as SnAIH. Forty\u2010three lacked complete autoantibody testing, most commonly anti\u2010SLA\/LP. After comprehensive re\u2010evaluation, only 9 patients (1.18%) fulfilled criteria for true SnAIH. All presented acutely with markedly elevated transaminases (median ALT 16.1\u2009\u00d7\u2009ULN); five had elevated IgG levels. Histology suggestive of autoimmune\u2010like drug\u2010induced liver injury was observed in four cases. All but one relapsed after treatment withdrawal, and 42.9% failed to normalize ALT at six months. In conclusion, SnAIH is rare (~1%), highlighting the importance of standardized, comprehensive autoantibody testing and re\u2010testing according to the guidelines.<\/jats:p>","DOI":"10.1111\/liv.70669","type":"journal-article","created":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T06:19:51Z","timestamp":1777702791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Seronegative Autoimmune Hepatitis in Adults Is a Rare Entity Often Obscured by Suboptimal Diagnostic Assessment"],"prefix":"10.1111","volume":"46","author":[{"given":"Francesca","family":"Colapietro","sequence":"first","affiliation":[{"name":"Division of Internal Medicine and Hepatology, Department of Gastroenterology IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3227-9846","authenticated-orcid":false,"given":"Charlotte D.","family":"Slooter","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC, AGEM Institute, Vrije Universitet Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Zachou","sequence":"additional","affiliation":[{"name":"Department of Medicine and Research Laboratory of Internal Medicine National Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER), General University Hospital of Larissa  Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"di Zeo S\u00e0nchez","sequence":"additional","affiliation":[{"name":"UGC Aparato Digestivo, Servicio De Farmacolog\u00eda Cl\u00ednica Instituto De Investigaci\u00f3n Biom\u00e9dica De M\u00e1laga\u2010IBIMA, Hospital Universitario Virgen De La Victoria, Universidad De M\u00e1laga  M\u00e1laga Spain"},{"name":"Centro De investigaci\u00f3n En Red En El \u00e1rea tem\u00e1tica De Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd), Madrid  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2365-2787","authenticated-orcid":false,"given":"Mercedes","family":"Robles\u2010D\u00ecaz","sequence":"additional","affiliation":[{"name":"UGC Aparato Digestivo, Servicio De Farmacolog\u00eda Cl\u00ednica Instituto De Investigaci\u00f3n Biom\u00e9dica De M\u00e1laga\u2010IBIMA, Hospital Universitario Virgen De La Victoria, Universidad De M\u00e1laga  M\u00e1laga Spain"},{"name":"Centro De investigaci\u00f3n En Red En El \u00e1rea tem\u00e1tica De Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd), Madrid  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mire","family":"Garc\u00eca\u2010Cort\u00e9s","sequence":"additional","affiliation":[{"name":"UGC Aparato Digestivo, Servicio De Farmacolog\u00eda Cl\u00ednica Instituto De Investigaci\u00f3n Biom\u00e9dica De M\u00e1laga\u2010IBIMA, Hospital Universitario Virgen De La Victoria, Universidad De M\u00e1laga  M\u00e1laga Spain"},{"name":"Centro De investigaci\u00f3n En Red En El \u00e1rea tem\u00e1tica De Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd), Madrid  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Santopietro","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-1333","authenticated-orcid":false,"given":"Vincenzo","family":"Ronca","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hepatology, Department of Gastroenterology IRCCS Humanitas Research Hospital  Rozzano Milan Italy"},{"name":"Department of Biomedical Sciences Humanitas University  Pieve Emanuele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Pia","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hepatology, Department of Gastroenterology IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Gerussi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca  Monza Italy"},{"name":"Division of Gastroenterology Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER), Fondazione IRCCS San Gerardo Dei Tintori  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3262-1998","authenticated-orcid":false,"given":"Pietro","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca  Monza Italy"},{"name":"Division of Gastroenterology Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER), Fondazione IRCCS San Gerardo Dei Tintori  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1565-0757","authenticated-orcid":false,"given":"Ra\u00fal J.","family":"Andrade","sequence":"additional","affiliation":[{"name":"UGC Aparato Digestivo, Servicio De Farmacolog\u00eda Cl\u00ednica Instituto De Investigaci\u00f3n Biom\u00e9dica De M\u00e1laga\u2010IBIMA, Hospital Universitario Virgen De La Victoria, Universidad De M\u00e1laga  M\u00e1laga Spain"},{"name":"Centro De investigaci\u00f3n En Red En El \u00e1rea tem\u00e1tica De Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd), Madrid  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George 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