title: PBC-AIH overlap syndrome with concomitant ITP and Hashimoto's disease with positivity for anti-centromere antibody.
abstract: We report a case of primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome with concurrent idiopathic thrombocytopenic purpura (ITP) and Hashimoto's disease with positivity for anticentromere antibody. The patient was a 64-year-old woman with symptoms of jaundice and general fatigue. About 30 years earlier, she had been diagnosed as having ITP and had undergone splenectomy. As part of her present history, she had exhibited liver dysfunction in 1995, during the follow-up of Hashimoto's disease, and a liver biopsy led to the diagnosis of PBC. In March 2000, she was admitted to hospital because of general fatigue and jaundice. Blood tests revealed: total protein (TP), 6.6 g/dl; gamma-globulin (glb), 35.9%; total bilirubin (T-bil), 9.41 mg/dl; direct bilirubin (D-bil), 7.52 mg/dl; aspartate aminotransferase (AST), 957 U/l; alanine aminotransferase (ALT), 651 U/l; alkaline phosphatase (ALP), 595 U/l; gamma-guanosine triphosphate (GTP), 129 U/l; IgG, 2620 mg/dl; IgM, 223 mg/dl; hepatitis B surface antigen (HBsAg), negative; anti-hepatitis C virus (HCV), negative; antinuclear antibody, positive; antimitchondrial antibody (AMA), negative (by the immunofluorescence [IF] method); and anti-pyruvate dehydrogenase complex (PDC)-E2 antibody, positive (by Western blotting). Anticentromere antibody (ACA), which is an alternative diagnostic marker for PBC, was detected in this patient. Prednisolone was administered after admission and liver function test results improved markedly. The liver biopsy in 1995 had revealed infiltration of lymphocytes and plasma cells in the portal areas with fibrous expansion and periportal necrosis. Destructive cholangitis was observed, as well as scattered epitheloid cell granulomas in some portal areas. Liver biopsy after the steroid treatment revealed alleviated necrotic inflammatory responses of hepatocytes, while the destructive cholangitis persisted. This is a very rare case of PBC-AIH overlap syndrome accompanied by ITP and Hashimoto's disease which provides a possible insight into the mechanisms and interplay of autoimmune diseases.
authors.affiliation: Third Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Arakawa
authors.forename: Shuichi
authors.initials: S
authors.lastname: Amaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyakawa
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Sakai
authors.forename: Iori
authors.initials: I
authors.lastname: Gotou
authors.forename: Naohide
authors.initials: N
authors.lastname: Tanaka
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Moriyama
authors.forename: Ariyoshi
authors.initials: A
authors.lastname: Iwasaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sugitani
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Arakawa
mesh_terms: D000906:Antibodies; D002503:Centromere / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D013577:Syndrome; D013967:Thyroiditis, Autoimmune / Q000150:complications*
chemical_list: D000906:Antibodies; D005938:Glucocorticoids; D011239:Prednisolone