Autoimmune liver disease is predominantly characterized by autoimmune hepatitis and primary biliary cholangitis. In clinical practice, patients with autoimmune liver disease may progress to cirrhosis and subsequently develop multiple complications of decompensated cirrhosis, such as ascites, hepatic encephalopathy, and gastrointestinal hemorrhage. However, spontaneous hepatic rupture hemorrhage in patients with autoimmune liver disease is exceedingly rare. This article presents a case of presumed spontaneous hepatic rupture hemorrhage in a patient with autoimmune hepatitis-primary biliary cholangitis overlap syndrome and cirrhosis. Through multidisciplinary evaluation, conservative management was selected, achieving successful hemostasis. This report aims to provide a reference for the clinical recognition and management of such rare complications.