Anti-SLA and AMA-positive celiac disease: A report of two cases and evaluation of autoimmune liver serology

Background and Aim: Antibodies to soluble liver antigen (anti-SLA) and anti-mitochondrial autoantibodies (AMA) are two specific serological markers of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). They are rarely detected in the sera of patients with non-liver autoimmune disorders. The biochemical, serological, and histological findings of two celiac disease (CD) patients who were seropositive for anti-SLA and/or AMA were evaluated. The data of two female patients who were 28 and 34 years old at the time of CD diagnosis were analyzed. The first patient presented with elevated liver function tests (LFTs) and immunoglobulin (Ig) G values. She was seropositive for both anti-SLA and AMA. A liver biopsy suggested features of AIH but no bile duct injury was noted. In addition to a gluten-free diet (GFD), immunosuppressive therapy was administered to normalize the LFTs. The second patient presented with elevated LFTs, a high IgG level, and a positive anti-SLA finding. A GFD was initiated, which resulted in an excellent clinical and biochemical response. Seropositivity for AMA in the first patient and anti-SLA in the second patient remained unchanged during follow-up but neither patient developed primary biliary cholangitis or AIH. Despite the high specificity of anti-SLA and AMA, these autoantibodies can be detected in CD without having any clinical relevance.