Refractory autoimmune hepatitis in children: Considerations for assessment and management

Figure 3 Sequential liver biopsies in a patient with refractory autoimmune hepatitis with a change of phenotype to primary sclerosing cholangitis over time. A: Index biopsy showing features compatible with autoimmune hepatitis; portal plasma cell-rich infiltrate with interface hepatitis; B: Perivenular infiltrate with hepatocyte dropout [A and B: Hematoxylin-eosin (HE) × 200]; C: Early bridging fibrosis was present at time of index biopsy (Masson trichrome × 40); D and E: Follow-up biopsy after 10 years; resolution of inflammation (D) (HE × 40); subtle biliary features with an “onion skin” sclerosing bile duct lesion (E) (HE × 200); F: Sclerosing bile duct on collagen stain (Haematoxylin van Gieson × 200).