title: Subtle presentation of active primary biliary cirrhosis in chronic hepatitis B: a case report.
abstract: We are describing an interesting case of two chronic liver diseases in a 48-year-old Chinese woman. While chronic hepatitis B is a common entity in Asia, the patient was later found to have active, asymptomatic primary biliary cirrhosis due to a persistently elevated alkaline phosphatase level after optimal hepatitis B virus DNA suppression on antiviral therapy. This report emphasizes the importance of keeping a high index of suspicion for another potential liver disease process even after a patient has been successfully treated for a primary liver condition. Clinical vigilance, especially in atypical clinical presentations, can result in early accurate diagnosis and prompt treatment.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA and.
authors.forename: Asad
authors.initials: A
authors.lastname: Javaid
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA and.
authors.forename: Mugilan
authors.initials: M
authors.lastname: Poongkunran
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Felicia D
authors.initials: FD
authors.lastname: Allard
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA and.
authors.forename: Win
authors.initials: W
authors.lastname: Kyaw
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA and.
authors.forename: Htet Htet
authors.initials: HH
authors.lastname: Maung
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA and dlau@bidmc.harvard.edu.
authors.forename: Daryl
authors.initials: D
authors.lastname: Lau
keywords: alkaline phosphatase; anti-mitochondrial antibodies; cholestatic disease; chronic hepatitis B; primary biliary cirrhosis