Abstract
BackgroundWe present a case of primary biliary cholangitis diagnosed during pregnancy. Diagnosis of this entity in pregnancy is infrequent, and when everything seemed to point to a simple obstetric cholestasis, close attention to the details of the clinical history was required to raise suspicion of the true diagnosis.Case presentationWe present a 37-year-old Portuguese Caucasian patient who complained of generalized pruritus and showed alteration in hepatic function tests with a cholestatic pattern. The first diagnostic hypothesis was intrahepatic cholestasis of pregnancy, and she began treatment with ursodeoxycholic acid, which resulted in slight improvement of cholestasis. Her pregnancy was also complicated with occlusive hemorrhagic placenta, and at 30 weeks she underwent emergency cesarean section due to heavy blood loss. However, careful observation of clinical and laboratory findings, postpartum evolution, and a multidisciplinary approach to the patient led to the probable diagnosis of primary biliary cholangitis.ConclusionsPhysiological changes during pregnancy can mimic chronic liver disease that can only be revealed at this stage, having an impact not only on the pregnancy but on the entire future of the woman.
Highlights
We present a case of primary biliary cholangitis diagnosed during pregnancy
Physiological changes during pregnancy can mimic chronic liver disease that can only be revealed at this stage, having an impact on the pregnancy but on the entire future of the woman
By increasing the metabolism and concentration of sex hormones and changes in the dynamics of plasmatic fluids, these changes may extend to the maternal liver, becoming apparent through signs and symptoms such as palmar erythema and telangiectasias, pruritus, and changes in the hepatic biochemical profile, which may mimic chronic liver disease [2, 3]
Summary
We present a case of primary biliary cholangitis diagnosed during pregnancy. Diagnosis of this entity in pregnancy is infrequent, and when everything seemed to point to a simple obstetric cholestasis, close attention to the details of the clinical history was required to raise suspicion of the true diagnosis.Case presentation: We present a 37-year-old Portuguese Caucasian patient who complained of generalized pruritus and showed alteration in hepatic function tests with a cholestatic pattern. The total concentration of bile acids does not change, and albumin levels decrease 20–40% due to the increase in plasma volume and the decrease in its production.
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