We report the case of a 24 year old Haitian woman who died of hepatocellular carcinoma  after seven years evolution  of a chronic active autoimmune hepatitis.

Upon initial evaluation in 1994 the patient complained of fatigue and jaundice and presented with splenomegaly. The work up revealed a mixed cytolytic and cholestatic profile. Echographic findings were a homogeneous liver, a splenomegaly and normal biliary system. Viral serologies were negative. Serum protein electrophoresis showed an increase in gamma globulins. Although initially negative, serum antismoothmuscle and antinuclear antibodies later became positive. A liver biopsy revealed  a chronic hepatitis in activity with disecting fibrosis.

She was treated with prednisone and 6MP with good clinical and biochemical success.  In 1998, as the liver fuction tests and gammaglobulin levels were normal, a liver biopsy was performed with the aim of discontinuing 6MP. It revealed an active chronic hepatitis with the presence of regenerative nodules. The echographic evaluation of the liver was normal at that time. Despite the increase of the immunotherapy, she presented three months later with a marked enlarged liver and  an alpha foeto protein level of over 50 000 µg/L. The MRI showed a multicentric involvement. She also had lung metastasis.

This is, to our knowledge, one of the rare case reported of hepatocellular carcinoma arising from autoimmune hepatitis.

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