title: Presence of anti-mitochondrial antibodies and elevated serum immunoglobulin G levels: is this primary biliary cirrhosis-autoimmune hepatitis overlap syndrome?
abstract: Primary biliary cirrhosis in combination with autoimmune hepatitis has been termed "overlap syndrome", but its diagnosis is challenging. We report a case of a 43-year-old lady who presented with a six-month history of jaundice and pruritus. She subsequently developed gum bleeds. Laboratory investigations revealed hypochromic microcytic anemia, abnormal coagulation profiles, elevated serum alanine transferase and alkaline phosphatase levels, and raised serum IgG and IgM levels. Her serum was also positive for anti-nuclear and anti-mitochondrial antibodies. The findings from her abdominal CT scan were suggestive of early liver cirrhosis and the histopathological examination results of her liver biopsy were consistent with primary biliary cirrhosis. The patient was treated with ursodeoxycholic acid and her liver function test parameters normalized after six months.
authors.affiliation: Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Najihan Abdul Samat
authors.initials: NA
authors.lastname: Muttaqillah
authors.affiliation: Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Asrul
authors.initials: A
authors.lastname: Abdul Wahab
authors.affiliation: Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Chuan Hun
authors.initials: CH
authors.lastname: Ding
authors.affiliation: Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Marlyn
authors.initials: M
authors.lastname: Mohammad
authors.affiliation: Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Suvra
authors.initials: S
authors.lastname: Biswas
authors.affiliation: Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Md Mostafizur
authors.initials: MM
authors.lastname: Rahman
keywords: anti-mitochondrial antibody; anti-nuclear antibody; autoimmune hepatitis; overlap syndrome; primary biliary cirrhosis