Autoimmune hepatitis, AIH, is a chronic liver disease that tends to be prolonged and difficult to cure, and is characterized by recurrent episodes. However, the heterogeneity of AIH determines the diversity of its manifestations. Recently, a case of AIH was admitted to our hospital. Li╳╳, female, 57 years old, highly fatigue, yellow urine and other symptoms, checking the liver function of TBIL to 350umol/L, ALB25g/L, plasminogen activity <40, INF>1.5 were all in line with the diagnosis of liver failure, and the condition was extremely dangerous. The condition rapidly improved, and when the condition was stabilized, the liver histopathology was examined. Interpretation of liver pathology: the confluent area was enlarged, the confluent-confluent, the confluent-central vein formed bridging necrosis, localized fusion necrosis, the liver plate around the central vein was destroyed, the arrangement of hepatocytes was disorganized, the lesion involved the whole lobule, a large number of hepatocytes ballooned, the bile salts of the hepatocytes around the confluent area were deposited, the mallory vesicles and the feathery metaplasia were seen, the rosette-like regeneration of the hepatocytes was seen, and the megakaryocytes could be seen. Inflammatory cells are predominantly lymphocytic infiltration with scattered plasma cells, interlobular bile duct epithelial cells are disorganized, basement membrane is disrupted, hering ducts are hyperplastic, and septal bile ducts are normal. Fibrous encapsulation separated the hepatic lobules, and cirrhosis was not fully formed. This is a case of an acute attack on a chronic basis, presenting as liver failure, and the progression of the disease was rapidly controlled due to accurate judgment and correct treatment by the clinician. This case review experience: the heterogeneity of AIH determines that AIH will present acute onset, acute onset of AIH contains two forms: acute deterioration on the basis of chronic disease and acute AIH without chronic disease in the true sense. typical AIH presents a chronic course, but as many as 25% of the patients with AIH may present acute onset, a small portion of which may progress to autoimmune acute liver failure ( AI-ALF). Acute-onset AIH is usually characterized by a short duration of illness (<30 days) without a clear history of previous liver disease, marked clinical symptoms (e.g., jaundice, fatigue, fever, nausea, and general malaise), and marked serologic abnormalities (serum ALT more than five times above the upper limit of normal, and bilirubin levels >2 mg/dL). Central lobular necrosis (CN) is a hepatic histologic feature of acute onset AIH, and its timely detection facilitates early diagnosis and intervention. In the comprehensive and simplified diagnostic score system proposed by the IAIHG, autoantibodies and serum IgG levels (in this case, IgG 34.66, 2-fold higher) are two important factors for diagnosing AIH, which are often missing in acute-onset AIH. The simplified diagnostic score system can only diagnose 24% of patients with acute AIH, whereas the comprehensive diagnostic score system can diagnose 40% of patients with acute AIH. The U.S. Acute Liver Failure Collaborative Network reports that 10% of patients with acute liver failure are caused by AIH, and an additional 30% of patients with acute liver failure are “seronegative,” some of which may be AIH.The pathology of this case highly supports the passage of acute AIH, with the presence of peri-zonal inflammatory necrosis in the hepatic tissue around zone 3, which is considered to be characteristic of the injury. This case is highly supportive of an acute AIH episode with inflammatory necrosis of liver tissue around zone 3, which is considered a characteristic injury.