INTRODUCTION
Autoimmune hepatitis (AIH) is a group of diseases characterized by necro-inflammatory liver damage, the presence of specific autoantibodies, elevated γ-globulin and high sensitivity to corticosteroid therapy. Although epidemiological data are limited, the prevalence of AIH ranges from 11 to 17 per 100,000 population with a north-south gradient.1, 2 This disease is rarely reported in sub-Saharan Africa.1, 3 She’s probably underdiagnosed. The diagnosis of AIH is based on criteria updated by the International Autoimmune Hepatitis Group (IAHG) in 1999.2, 3 Despite the presence of these criteria, diagnosis remains difficult, especially in low-income countries.1 Because the investigations are expensive to rule out other diseases that may resemble it. In addition, liver biopsy remains unavailable in some countries. Treatment is based on corticosteroid therapy followed by an immunomodulator.4, 5, 6 In Madagascar, no case has yet been described on the AIH. We report two cases of autoimmune hepatitis diagnosed and followed up in a department of Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. We will discuss the diagnostic difficulties compared to the investigations available and the treatment compared to that currently recommended.