Further autoantibody testing may be helpful, in particular for those patients testing initially negative in the above assays. Antineutrophil cytoplasmic antibodies (ANCA) are detected using ethanol-fixed human neutrophils with serum diluted 1:20. Atypical pANCA antibodies, originally considered specific of PSC and inflammatory bowel disease, are also frequently present in patients with AIH-1 [  ,  ]. Recent evidence indicates that the target antigen is located in the nuclear membrane and for this reason some authors describe these antibodies as perinuclear anti-neutrophil nuclear antibodies (p-ANNA) [  ,  ]. Their positivity can be an additional element used towards the diagnosis of AIH, particularly if other autoantibodies are negative [  ,  ]. AMA, the specific serologic marker of PBC diagnosis, can be occasionally detected (8–12%) [  ,  ] in patients with the classical phenotype of AIH without any other evidence of PBC, and may hint at co-existent or underlying PBC. Nonetheless, these patients should be classified and treated according to their clinical phenotype.
i was playing footbal and a person landed on top of my inner shoulder. i first felt pain on the top, outside part of my left pectoral muscle. now I have pain on left inner tip of my collar bone and the left side of my neck, no further than the bottom of my throut. the pain is on the left side of my neck down to the inside tip of the collar bone… i am able to move my left arm in many ways but i sometimes feel a little pain. i am not able to reach out for objets without feeling some pain. what can it be, and how long will the pin last