Viral, autoimmune and metabolic hepatitis — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in a general paediatric clinic. A thirteen-year-old girl is referred with three months of worsening fatigue, yellowing of the eyes, acne, loss of her periods and aching joints. Her immunoglobulin G is twenty-five grams per litre and her antinuclear antibody is positive at one in six hundred forty. The viral hepatitis serology, including hepatitis B and C, is negative. The liver biopsy shows interface hepatitis with a dense plasma-cell infiltrate. The team asks you to establish the diagnosis and its type, to apply the diagnostic score, to outline the induction treatment with the safety checks, to exclude the overlap condition, and then to counsel the family on the outlook and the monitoring. You have twelve minutes with the team and five minutes for examiner discussion. ^[8]