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Volume 6
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Review

Beyond the Liver: A Systematic Symptom-Based Approach to Extrahepatic Manifestations in Autoimmune Hepatitis

by
Dante Pio Pallotta
1,*,
Francesco Tovoli
1,2,
Elisa Barbaro
1,
Andrea De Sinno
1,
Matteo Cappelli Aimone Chiorat
1,
Ernestina Santangeli
1 and
Fabio Piscaglia
1,2
1
Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
2
Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
*
Author to whom correspondence should be addressed.
Livers 2026, 6(2), 32; https://doi.org/10.3390/livers6020032
Submission received: 14 December 2025 / Revised: 1 February 2026 / Accepted: 10 April 2026 / Published: 17 April 2026
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Abstract

Autoimmune hepatitis (AIH) has long been regarded as an organ-specific disorder. However, increasing evidence supports its systemic nature, with extrahepatic manifestations representing key aspects of clinical management. These manifestations can affect musculoskeletal, gastrointestinal, haematologic, and other systems. They also reflect the complex interplay between systemic inflammation, concomitant autoimmune diseases, and drug-related toxicity. A careful evaluation is therefore essential to distinguish between these scenarios, especially for symptoms like fatigue and cytopenias. This narrative review provides a comprehensive, symptom-based overview of extrahepatic clinical and laboratory findings in AIH. By integrating current evidence with practical diagnostic considerations, it aims to offer clinicians a patient-centred and clinically relevant framework for navigating the multifaceted systemic landscape of AIH.
Keywords: autoimmune hepatitis; autoimmune liver disease; diabetes mellitus; autoimmune disease; arthritis; anaemia; cytopenia; fatigue; comorbidity; celiac disease autoimmune hepatitis; autoimmune liver disease; diabetes mellitus; autoimmune disease; arthritis; anaemia; cytopenia; fatigue; comorbidity; celiac disease

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MDPI and ACS Style

Pallotta, D.P.; Tovoli, F.; Barbaro, E.; De Sinno, A.; Cappelli Aimone Chiorat, M.; Santangeli, E.; Piscaglia, F. Beyond the Liver: A Systematic Symptom-Based Approach to Extrahepatic Manifestations in Autoimmune Hepatitis. Livers 2026, 6, 32. https://doi.org/10.3390/livers6020032

AMA Style

Pallotta DP, Tovoli F, Barbaro E, De Sinno A, Cappelli Aimone Chiorat M, Santangeli E, Piscaglia F. Beyond the Liver: A Systematic Symptom-Based Approach to Extrahepatic Manifestations in Autoimmune Hepatitis. Livers. 2026; 6(2):32. https://doi.org/10.3390/livers6020032

Chicago/Turabian Style

Pallotta, Dante Pio, Francesco Tovoli, Elisa Barbaro, Andrea De Sinno, Matteo Cappelli Aimone Chiorat, Ernestina Santangeli, and Fabio Piscaglia. 2026. "Beyond the Liver: A Systematic Symptom-Based Approach to Extrahepatic Manifestations in Autoimmune Hepatitis" Livers 6, no. 2: 32. https://doi.org/10.3390/livers6020032

APA Style

Pallotta, D. P., Tovoli, F., Barbaro, E., De Sinno, A., Cappelli Aimone Chiorat, M., Santangeli, E., & Piscaglia, F. (2026). Beyond the Liver: A Systematic Symptom-Based Approach to Extrahepatic Manifestations in Autoimmune Hepatitis. Livers, 6(2), 32. https://doi.org/10.3390/livers6020032

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