Autoimmune hepatitis and celiac disease are two immune-mediated conditions, with proven association with each other. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune or immune-based entity in which the existence of IgG antibodies against platelet surface causes thrombocytopenia. The association between autoimmune hepatitis with idiopathic thrombocytopenic purpura and between celiac disease and idiopathic thrombocytopenic purpura has been previously described. We report the case of a 4 year old girl who presents with anemia and Idiopathic thrombocytopenic purpura, along with celiac disease and autoimmune hepatitis.

Introduction: The prognosis of autoimmune hepatitis (AIH) depends on the diagnosis and early treatment. However, specific diagnosis markers remain unknown. The international group for the AIH created a diagnostic score, but there is uncertainty about its validity in paediatrics.
Purpose: Analysis of the diagnostic ability of the score between 0 and 23 years old.
Patients and methods: Retrospective study (February 1994-December 2010) of 0 to 23 year-old patients diagnosed of AIH according to clinical, laboratory, serological and pathological findings. The score is applied pre and post-treatment.
Results: 10 patients were included. Pre-treatment AIH score diagnoses "definitive" in 3 patients, "probable" in 5 and "exclusion" in 2. Replacement of cholestasis marker "alkaline phosphatase" (AP) by "gamma-glutamyl-transferase" (GGT) alters the classification of 2 patients with "probable" to "definitive", and "exclusion" to "probable" sense. Removal of the indicator "alcohol" does not induce changes. The post-treatment AIH score diagnoses "definitive" in 6 patients and "probable" in 4, with no changes inducing the elimination of the "alcohol" marker and as do replacing AF by GGT (1 patients with variation from "probable" to "definitive").
Conclusions: All patients responded to immunosuppressive agents steadily and did not develop cholestasis. This supports the diagnosis of AIH regardless of the score. The score should be cautiously interpreted because it does not allow any diagnostic exclusion, with superior value post-treatment. The replacement of "AP" indicator for "GGT" should be considered.