P1897 - Primary Biliary Cholangitis Unveiled by Positive Anti-Centromere Antibodies

Luis A. Penaranda Bolano, MD, Natasha Mederos-Rocha, MD
University of Miami Miller School of Medicine at Holy Cross Hospital, Fort Lauderdale, FL

Introduction: Primary Biliary Cholangitis (PBC) is an autoimmune liver disease characterized by the immune-mediated destruction of small and medium intrahepatic bile ducts. The disease is distinguished by the presence of the anti-mitochondrial antibody (AMA) in 90-95% of patients.

Case Description/Methods: A 20-year-old primigravida at 28.3 weeks gestation was initially admitted to an outside hospital eight days prior to transfer due to twenty days of nausea, emesis, and dehydration without abdominal pain, fever, chills, or diarrhea. At that time admission findings included acute kidney injury, leukocytosis, and hypokalemia (K 2.6), along with markedly elevated total bilirubin (3.7), AST (1251), ALT (1890), and alkaline phosphatase (170) with an unremarkable right upper quadrant ultrasound. Further work-up revealed low IgG levels (547), positive ANA (1:160), and positive anti-centromere antibodies. Serological tests for viral hepatitis and other infections were negative.Given the positive ANA, autoimmune hepatitis was also considered, prompting transfer to a tertiary center for comprehensive evaluation. Rheumatology service was consulted to evaluate the presence of underlying systemic sclerosis given the abnormal antibodies findings. Upon evaluation at the hospital, the patient was asymptomatic. She reported regular follow-up with an obstetrician. Denied any family history of autoimmune disease, over-the-counter medications, new medications, or herbal supplements. A transthoracic echocardiogram was performed, which showed a normal ejection fraction and normal right systolic ventricular pressure and no valvulopathy. After rheumatology evaluation, anti-mitochondrial M2 antibodies came back elevated with negative anti-smooth muscle antibodies. The patient was started on ursodiol for pruritus with further improvement of the symptoms and liver enzyme levels and was discharged to follow up with outpatient hepatology.

Discussion: Positive anti-centromere antibodies (ACA) in the context of abnormal liver tests cannot be overstated, as it strongly correlates with the presence of primary biliary cholangitis (PBC) and may aid in early disease diagnosis. It is important to have a multidisciplinary approach in managing patients with autoimmune diseases and interpreting such tests, facilitating timely diagnosis and optimized patient care


Disclosures:


Luis A. Penaranda Bolano, MD, Natasha Mederos-Rocha, MD. P1897 - Primary Biliary Cholangitis Unveiled by Positive Anti-Centromere Antibodies, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.