Hepatic overlap syndrome: Glass of autoimmune mimicry - half empty and half filled

Objective: to unfold the iceberg entity of hepatic overlap syndrome among patient with established chronic liver diseases. methodology: forty-one patients were referred from the remote areas of sindh province during march 2008 to august 2010 to department of internal medicine at civil hospital,karachi,pakistan. these patients were unresponsive to the treatment(s) being prescribed. the complete biochemical,clinical,serological and histopathological profiles of these patients was assessed. the chazouillères criterion was used to diagnose the overlap syndrome cases (according to which an aih-pbc overlap syndrome would be accepted when 2 out of 3 criteria each of aih or pbc is fulfilled). data were analyzed through spss version 16.0. frequencies and means were calculated. serological markers were correlated against biopsy patterns by pearson's,cramer's v test,mantel-haenszel test to measure the odd of getting the particular biopsy pattern and 2- sided significance level <0.10 was taken as significant. results: out of 41 patients,23 had aih or pbc (56.09%) and the other 18 (43.90%) were having cld secondary to wilson's disease (9 patients),fatty liver (4 patients),hepatitis b (3 patients) and hepatitis c (2 patients). further workup in 23 patients showed that 10 out of 23 were having aih/pbc overlap. fatigue was the most common clinical symptom among overlap syndrome patients (80%). 3 patients were having hashimoto's thyroiditis and one male was diagnosed with sle. conclusion: we emphasize and recommend for detail investigations to consider such entity for autoimmune chronic liver disease,where initial laboratory investigations do not support the exact diagnosis among cld patients. since no work has been done so far on overlap syndrome in our set up,we suggest multicentre prevalence surveys to develop proper treatment guidelines for indo-pakistan population.