{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:34:24Z","timestamp":1786361664264,"version":"build-2736575974"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Case Rep"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Overlap syndrome refers to the coexistence of more than one immune-mediated liver disease in a single patient. Primary sclerosing cholangitis\u2013autoimmune hepatitis (PSC\u2013AIH) overlap is a rare but clinically important entity, as delayed recognition may lead to progressive liver injury, cirrhosis, and liver failure. Differentiating this condition from isolated PSC or AIH remains challenging due to overlapping clinical, biochemical, and radiological features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 20-year-old male presented with progressive jaundice, pruritus, acholic stools, and dark urine for one month. Laboratory evaluation revealed marked cholestasis with significantly elevated alkaline phosphatase and transaminases, hyperbilirubinemia, and coagulopathy, while viral and metabolic causes were excluded. Magnetic resonance cholangiopancreatography demonstrated characteristic intrahepatic biliary duct irregularities consistent with primary sclerosing cholangitis. However, disproportionately elevated alanine aminotransferase and serum immunoglobulin G levels prompted further evaluation. Liver biopsy revealed features of both diseases, including interface hepatitis with chronic portal inflammation and plasma cell infiltration, along with bile duct injury, ductopenia, and onion-skin fibrosis. Based on histology and diagnostic scoring, a diagnosis of PSC\u2013AIH overlap syndrome was established. The patient was treated with ursodeoxycholic acid, corticosteroids, and azathioprine, resulting in marked clinical and biochemical improvement on follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of considering PSC\u2013AIH overlap syndrome in young patients with cholestatic liver disease and unexpectedly elevated transaminases or immunoglobulin G levels. Early recognition and combined immunosuppressive and supportive therapy can lead to favorable outcomes and may prevent irreversible liver damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795476261470617","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T22:42:36Z","timestamp":1786142556000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cFrom Cholestasis to Interface Hepatitis: A Rare Case of Primary Sclerosing Cholangitis\u2013Autoimmune Hepatitis Overlap in a 20-Year-Old Male\u201d"],"prefix":"10.1177","volume":"19","author":[{"given":"M. Hassaan","family":"Shah","sequence":"first","affiliation":[{"name":"Khyber Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aeman Daud","family":"Sethi","sequence":"additional","affiliation":[{"name":"Khyber Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-4264","authenticated-orcid":false,"given":"Muhammad","family":"Osama","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samar","family":"Hasnain","sequence":"additional","affiliation":[{"name":"Khyber Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahat","family":"Shah","sequence":"additional","affiliation":[{"name":"Mardan Medical Complex"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan","family":"khan","sequence":"additional","affiliation":[{"name":"Khyber Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamir","family":"Khan","sequence":"additional","affiliation":[{"name":"Khyber Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawan Kumar","family":"Thada","sequence":"additional","affiliation":[{"name":"Sotang Primary Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"issue":"7","key":"e_1_3_7_2_2","first-page":"OD07","article-title":"Autoimmune hepatitis\u2013primary biliary cirrhosis overlap syndrome","volume":"11","author":"Bairy I","year":"2017","unstructured":"Bairy I, Berwal A, Seshadri S. Autoimmune hepatitis\u2013primary biliary cirrhosis overlap syndrome. J Clin Diagn Res. 2017;11(7):OD07-OD09.","journal-title":"J Clin Diagn Res"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1159\/000440831"},{"key":"e_1_3_7_4_2","volume-title":"Current Medical Diagnosis & Treatment 2025","author":"Papadakis MA","year":"2025","unstructured":"Papadakis MA, Rabow MW, McQuaid KR, Gandhi M. Current Medical Diagnosis & Treatment 2025. 1st ed. 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Clinical manifestations and complications of inflammatory bowel disease in children and adolescents. In: Heyman MB, Hoppin AG, eds. UpToDate. UpToDate Inc; 2020."},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510280210"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcped.2013.09.020"},{"key":"e_1_3_7_18_2","first-page":"286","article-title":"Overlap syndrome (autoimmune hepatitis and primary sclerosing cholangitis) in a 13-year boy with ulcerative colitis","volume":"2","author":"Ali N","year":"2024","unstructured":"Ali N, Khan SA, Saleem A, Malik MI, Ahmerin A. Overlap syndrome (autoimmune hepatitis and primary sclerosing cholangitis) in a 13-year boy with ulcerative colitis. JCPSP Case Rep. 2024;2:286-288.","journal-title":"JCPSP Case Rep"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.14.3368"}],"container-title":["Clinical Medicine Insights: Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476261470617","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795476261470617","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476261470617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:19:05Z","timestamp":1786360745000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795476261470617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":18,"alternative-id":["10.1177\/11795476261470617"],"URL":"https:\/\/doi.org\/10.1177\/11795476261470617","relation":{},"ISSN":["1179-5476","1179-5476"],"issn-type":[{"value":"1179-5476","type":"print"},{"value":"1179-5476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"11795476261470617"}}