An unusual form of autoimmune hepatitis in young Somalian men

Background: Significant diversity in disease severity has been identified for autoimmune disorders among different ethnic groups. Current knowledge of both the natural history and management of autoimmune hepatitis (AIH) has been derived from European or Japanese patients, and there is limited information about the disease in patients from other ethnic groups. Aims: To assess the clinical, histological and immunological features of AIH in patients from Somalia and to determine their response to therapy. Methods: Retrospective review of a cohort of young Somalian men with atypical AIH compared with a control group of European patients. Results: The six Somalian men were younger at presentation (median age 37 (range 24-59) years) than the seven female and three male European controls (55 (34-54) years, P=0.06). The Somalians had slightly more severe disease at presentation-median modified Ishak stage of 2.5 compared with 2 in Europeans (P=0.61) and four (66%) had features of cholestasis compared with only one (10%) European patient (P=0.04). Therapy with prednisolone and azathioprine was completely effective for eight of 10 Europeans but only one of seven Somalians (P=0.04). Analysis of human leucocyte antigen types revealed differences between the Somalian and European patients, although these differences did not reach statistical significance. Conclusion: Somalian men with AIH present with cholestatic features and respond poorly to standard immunosuppressive regimes.