Wilson’s Disease and Autoimmune Hepatitis Coexistence: A Cause of Diagnostic Delay

Abstract

This case report describes a 27-year-old housewife who presented with a progressive and insidious onset of abdominal distension, loss of  appetite, and fatigue which started 3 months before her presentation. The physical assessment showed moderate ascites and small  liver size, and no other peripheral evidence of chronic liver disease was observed. A diagnosis of liver cirrhosis and was confirmed by  investigations and imaging, where ascites responded well to therapy with diuretics. Investigations for the cause of cirrhosis was  established through the diagnosis of autoimmune hepatitis, and she was started on steroids and azathioprine with partial improvement  in liver biochemistry. She presented 8 months later with neuropsychiatric symptoms in the form of slurred speech and difficulty walking.  Accordingly, Wilson’s disease was suspected to be the cause and further investigations confirmed this. A chelating agent, D penicillamine, was added to her immunosuppressive treatment. Nine months later she showed slow improvement in her neurological symptoms and  was referred for assessment for liver transplantation. Wilson’s disease, although rare, should be suspected in patients with  decompensated liver disease. The dominance of clinical and epidemiological features of autoimmune hepatitis as a common causative  pathology for chronic liver disease in young and middle-aged ladies may hide the presence of other serious different pathologies such as  Wilson’s disease.