Inappropriate Long-Term Steroid Therapy in Autoimmune Hepatitis Might Cause the Development of Non-Alcoholic Fatty Liver Disease; A Challenging Situation

Autoimmune hepatitis (AIH) is a chronic liver cell injury induced by immune mechanism. Steroid therapy +/- immunosuppressive therapy is the mainstay of treatment in AIH (1). Insulin resistance and obesity are the harmful consequences of injustice steroid therapy. These conditions predispose the AIH patients to the development of concomitant non-alcoholic fatty liver disease (NAFLD). NAFLD is already considered as the hepatic manifestation of insulin resistance (metabolic) syndrome (2). The management of NAFLD differs from AIH with regard to steroid therapy. While steroid is lifesaving in AIH due to immune modulation effect, its long-term use worsen the course of NAFLD because the development of insulin resistance. The elevation of serum aminotransferase levels in AIH patients on steroid therapy does not necessarily mean treatment failure. The development of NAFLD might be considered as a cause.