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A great mimicker of primary biliary cholangitis

Journal Volume 84 - 2021
Issue Fasc.3 - Clinical images
Author(s) B. Zwaenepoel 1, E. Padalko 2, A. Hoorens 3, S. Vanooteghem 4, P. Hindryckx 1
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Full Article
PAGES 527-527
(1) Division of gastroenterology and hepatology, Ghent University Hospital, Belgium
(2) Laboratory of medical microbiology, Ghent University Hospital, Belgium
(3) Division of pathology, Ghent University Hospital, Belgium
(4) Division of gastroenterology and hepatology, Waregem Regional Hospital, Belgium

A 59 year-old man without past medical history was referred with biochemical features of cholestasis (aspartate aminotransferase (AST) 117 U/L, alanine aminotransferase (ALT) 83 U/L, gamma-glutamyl transferase (GGT) 1307 U/L, alkaline phosphatase (AP) 1803 U/L, total bilirubin 0,7 mg/dL), a strongly positive antimitochondrial M2 antibody (AMA-M2) titer (88 U), weight loss and abdominal pain since several months. He did not take any medications, nor there was a history of alcohol abuse or sexual risk behavior. Upon presentation, clinical examination showed a rather cachectic patient (body mass index 19 kg/m²), without further abnormalities. As primary biliary cholangitis (PBC) was suspected, treatment with ursodeoxycholic acid had been initiated but did not improve the cholestasis nor the pain. Additional investigations didn’t reveal any other irregularities, except for a mildly dilated aortic sinus root of 42 mm. The histopathological findings of a liver biopsy are shown below (Figure 1). This showed granulomas with cholangitis and increased presence of neutrophils, which raised suspicion for an infectious cause.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 34599585