The Perils of Diagnosing and Treating Overlap Syndrome.

Autoimmune hepatitis (AIH) may present with clinical, laboratory abnormalities and histological features suggestive of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). These variants of AIH are known as overlap syndromes. We present a case of a 62 year-old-male who presented with altered liver function tests, anemia and unintentional weight loss. Initial laboratories revealed anemia and a cholestatic pattern. Diagnostic work-up was remarkable for a positive antinuclear antibodies (ANA) test and a liver biopsy suggestive of an AIH-PBC overlap syndrome. This case illustrates the complexity of establishing the diagnosis and effective therapy in this condition.