Overlapping of Primary Biliary Cirrhosis and Small Duct Primary Sclerosing Cholangitis: First Case Report

Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are both autoimmune cholestatic liver disease and the association of these two conditions in the same patient is very rare. We report the case of a female patient presenting with a cholestatic liver disease and a panel of autoantibodies specific for PBC, including antibodies to mitochondrial E2-pyruvate dehydrogenase, gp-210 and Sp-100. Beside these findings, the liver biopsy revealed concentric fibrosis of small biliary ducts and the magnetic resonance cholangiography presented no abnormal findings. Diagnosis of small duct PSC/PBC overlapping was done. No description of this association was found in the literature. Clinical and serological features of this unusual finding are discussed.

[1]  Lu Lun-ge,et al.  Overlap syndromes:the international autoimmune hepatitis group(IAIHG) position statement on a controversial issue , 2011 .

[2]  Gideon M. Hirschfield,et al.  Primary Biliary Cirrhosis , 2010 .

[3]  T. Karlsen,et al.  Update on primary sclerosing cholangitis. , 2010, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[4]  A. Czaja Autoantibodies as Prognostic Markers in Autoimmune Liver Disease , 2010, Digestive Diseases and Sciences.

[5]  A. Jeevagan Overlap of primary biliary cirrhosis and primary sclerosing cholangitis – a rare coincidence or a new syndrome , 2010, International journal of general medicine.

[6]  G. Gores,et al.  Diagnosis and management of primary sclerosing cholangitis , 2010, Hepatology.

[7]  P. Milkiewicz,et al.  Value of autoantibody analysis in the differential diagnosis of chronic cholestatic liver disease. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[8]  M. Kaplan,et al.  Primary biliary cirrhosis , 1998, Hepatology.

[9]  Paulo Luiz Carvalho Francescantônio,et al.  Third Brazilian Consensus for autoantibodies screening in HEp-2 cells (ANA). Recommendations for standardization of autoantibodies screening trial in HEp-2 cells, quality control and clinical associations , 2009 .

[10]  T. Karlsen,et al.  Autoantibodies in primary sclerosing cholangitis. , 2008, World journal of gastroenterology.

[11]  U. Beuers,et al.  Overlap syndromes among autoimmune liver diseases. , 2008, World journal of gastroenterology.

[12]  K. Boberg,et al.  The natural history of small-duct primary sclerosing cholangitis. , 2008, Gastroenterology.

[13]  J. Talwalkar,et al.  Overlap of Autoimmune Hepatitis and Primary Biliary Cirrhosis: Long-Term Outcomes , 2007, The American Journal of Gastroenterology.

[14]  P. Invernizzi,et al.  Interpreting serological tests in diagnosing autoimmune liver diseases. , 2007, Seminars in liver disease.

[15]  O. Chazouilleres,et al.  Long term outcome and response to therapy of primary biliary cirrhosis-autoimmune hepatitis overlap syndrome. , 2006, Journal of hepatology.

[16]  J. Kingham,et al.  Co-existence of primary biliary cirrhosis and primary sclerosing cholangitis: a rare overlap syndrome put in perspective , 2005, European journal of gastroenterology & hepatology.

[17]  R. Chapman,et al.  Review article: current management of primary sclerosing cholangitis , 2005, Alimentary pharmacology & therapeutics.

[18]  M. Manns,et al.  Liver autoimmune serology: a consensus statement from the committee for autoimmune serology of the International Autoimmune Hepatitis Group. , 2004, Journal of hepatology.

[19]  T. Therneau,et al.  Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. , 2003, Gastroenterology.

[20]  R. Poupon Autoimmune overlapping syndromes. , 2003, Clinics in liver disease.

[21]  Howard J Worman,et al.  Antinuclear antibodies specific for primary biliary cirrhosis. , 2003, Autoimmunity reviews.

[22]  G. Bianchi,et al.  Characterization and Clinical Impact of Antinuclear Antibodies in Primary Biliary Cirrhosis , 2003, American Journal of Gastroenterology.

[23]  K. Boberg,et al.  Patients with small duct primary sclerosing cholangitis have a favourable long term prognosis , 2002, Gut.

[24]  J. Heathcote Variant syndromes of autoimmune hepatitis. , 2002, Clinics in liver disease.

[25]  K. Lindor,et al.  Small‐duct primary sclerosing cholangitis: A long‐term follow‐up study , 2002, Hepatology.

[26]  M. Lenzi,et al.  The Hepatitic/Cholestatic "Overlap" Syndrome: An Italian Experience , 2002, Autoimmunity.

[27]  F. Cassani,et al.  Autoimmune serology of primary sclerosing cholangitis. , 2001, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[28]  D. Vergani,et al.  Autoimmune hepatitis/sclerosing cholangitis overlap syndrome in childhood: A 16‐year prospective study , 2001, Hepatology.

[29]  M. Swain,et al.  A case of coexisting primary biliary cirrhosis and primary sclerosing cholangitis: a new overlap of autoimmune liver diseases. , 2001, Digestive diseases and sciences.

[30]  K. Lindor,et al.  Serum autoantibodies in patients with primary sclerosing cholangitis. , 2000, Journal of hepatology.

[31]  A. Czaja Frequency and nature of the variant syndromes of autoimmune liver disease , 1998, Hepatology.

[32]  O. Chazouilleres,et al.  Primary biliary cirrhosis–autoimmune hepatitis overlap syndrome: Clinical features and response to therapy , 1998, Hepatology.

[33]  K. Lazaridis,et al.  Primary biliary cirrhosis , 1998, Springer Netherlands.

[34]  T. Sternsdorf,et al.  Prevalence, kinetics, and therapeutic modulation of autoantibodies against Sp100 and promyelocytic leukemia protein in a large cohort of patients with primary biliary cirrhosis , 1997, Hepatology.

[35]  K. Boberg,et al.  Features of autoimmune hepatitis in primary sclerosing cholangitis: An evaluation of 114 primary sclerosing cholangitis patients according to a scoring system for the diagnosis of autoimmune hepatitis , 1996, Hepatology.

[36]  R. Wiesner,et al.  Idiopathic adulthood ductopenia. A cause of chronic cholestatic liver disease and biliary cirrhosis. , 1988, Journal of hepatology.

[37]  R. Wiesner,et al.  Intrahepatic cholangiectases and large‐duct obliteration in primary sclerosing cholangitis , 1986, Hepatology.

[38]  L. Seeff,et al.  Primary biliary cirrhosis-primary sclerosing cholangitis overlap syndrome. , 1984, Archives of pathology & laboratory medicine.

[39]  R. Chapman,et al.  Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology. , 1980, Gut.

[40]  W. Ewig [Diseases of the bile ducts]. , 1961, Hippokrates.