A Case of Overlapping Autoimmune Sclerosing Cholangitis and Autoimmune Hemolytic Anemia

Abstract

This case study revolves around a 14-year old female patient, who was otherwise healthy and normal, but brought to the hospital for her condition. The patient presented with complaints of fever, sore throat, severe abdominal pain, and generalized body aches for the last two days. She appeared to be lethargic and weak. Her condition had made her fatigued and a yellowish tinge of the face and sclera was obvious, pointing towards a likely case of jaundice. Upon abdominal examination, the patient also had hepatomegaly and splenomegaly present, and the muscles appeared to be tender as well. The child was admitted to the hospital, where her lab investigations revealed that she was anemic. Other investigations revealed that her liver enzymes and bilirubin levels were significantly elevated. Her DAT was positive and there was a presence of high eosinophilia. However, her Hepatitis A, B, and C screening came out to be negative. She was kept as a suspected case of Autoimmune Hemolytic Anemia as it appeared to be the most probable diagnosis, given her condition, but following a biopsy she was also confirmed as a case of Autoimmune Sclerosing Cholangitis. Once the diagnosis was confirmed, the child was treated accordingly. This was a unique case because it involved a significant overlap in the presence of two diseases. Both of the diseases, although similar in appearance, could have caused great havoc if they were not separately diagnosed and treated accordingly. This case study deals with such an overlapping case that was brought to the hospital. With a myriad of confusing symptoms, it was obvious that the diagnosis could have been misdiagnosed or incorrectly diagnosed. However, the lab reports and examinations that were carried out smartly helped in excluding the other diagnoses which would have obviously lead to confusions and also in starting the wrong treatment. This case study deals with the examination, laboratory protocols, along with the association of symptoms, all of which help in reaching towards the final diagnosis in a timely manner and thus, helped treat the patient effectively. The case study also highlights how both of these diseases present in a patient of the younger population, and how they need to be managed effectively and efficiently to ensure that there are no complications that might alter the already deteriorating state of the patient.