Education case: A case-based approach to overlap autoimmune liver disease in patient with ulcerative colitis

Simultaneous occurrence of immune-based gastrointestinal diseases and autoimmune hepatitis although is not common but is of clinical importance. Some clinical and laboratory findings such as severe pruritus and an elevation in alkaline phosphatase raise suspicion of a biliary disease which overlaps autoimmune hepatitis. A strong clinical suspicion of overlap syndrome in a patient with autoimmune hepatitis prompts more diagnostic evaluations like MRCP, liver biopsy and secondary laboratory tests. Patients who fall into the category of overlap syndrome would be proceeded with timely monitoring of known complications including colorectal carcinomas, cholangiocarcinomas and gallbladder cancers. So, it is highly recommended to search for all simultaneous immune-based involvements prior to labelling a patient as having pure autoimmune hepatitis. In this study, attempts have been made to express all challenges about a case with overlap syndrome referred to gastroenterology ward of Taleghani hospital and review the latest articles and related guidelines about the diagnosis, treatment, complications, and surveillance of the mentioned patient with autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and inflammatory bowel disease (IBD).