{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:40:05Z","timestamp":1756305605661,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>An 18-year-old boy presented with upper gastrointestinal bleeding and jaundice. Investigations revealed coarse hepatomegaly, splenomegaly and advanced oesophageal varices. Blood reports showed marked rise of alkaline phosphatase and more than twofold rise of transaminases and IgG. Liver histology was suggestive of piecemeal necrosis, interphase hepatitis and bile duct proliferation. Antinuclear antibody was positive in high titre along with positive antismooth muscle antibody and antimitochondrial antibody. The patient was positive for human leukocyte antigen DR3 type. Although an \u2018overlap\u2019 syndrome exists between autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC), a cholestatic variant of AIH, a rare \u2018outlier\u2019 syndrome could not be excluded in our case. Moreover, \u2018the chicken or the egg\u2019, AIH or PBC, the dilemma for the internists continued. The patient was put on steroid and ursodeoxycholic acid with unsatisfactory response. The existing international criteria for diagnosis of AIH are not generous enough to accommodate its variant forms.<\/jats:p>","DOI":"10.1136\/bcr-2012-008335","type":"journal-article","created":{"date-parts":[[2013,2,8]],"date-time":"2013-02-08T23:09:50Z","timestamp":1360364990000},"page":"bcr2012008335","source":"Crossref","is-referenced-by-count":0,"title":["Autoimmune hepatitis in a teenage boy: \u2018overlap\u2019 or \u2018outlier\u2019 syndrome\u2014dilemma for internists"],"prefix":"10.1136","volume":"2013","author":[{"given":"Arunansu","family":"Talukdar","sequence":"first","affiliation":[{"name":"Department of Medicine, Medical College Kolkata, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dibbendhu","family":"Khanra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical College Kolkata, Kolkata, West Bengal, 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