Reactivation of Autoimmune Hepatitis During Budesonide Monotherapy, and Response to Standard Treatment

A case of a 22-year-old female with autoimmune hepatitis (AIH) demonstrated that budesonide monotherapy at 3×3mg per day was insufficient to maintain remission, leading to disease reactivation and significant steroid side-effects. The patient initially presented with elevated liver enzymes and was treated with prednisolone, which was later combined with budesonide due to side effects. Despite this, her AIH reactivated, prompting a switch to azathioprine and low-dose prednisolone, which successfully normalized liver enzymes and alleviated side effects. This case highlighted the potential limitations of budesonide in AIH treatment and emphasized the effectiveness of azathioprine combined with prednisolone. The authors suggested that azathioprine should be standard treatment for AIH, and further evaluation of budesonide's role is necessary.