Occasionally a patient with early primary biliary cirrhosis (PBC) may present with what is initially thought to be acute hepatitis.
The acute presentation may be a flare-up of early PBC activity triggered by:
(1) pregnancy
(2) smoking
(3) infection
The cause of the liver disease may be initially misdiagnosed if:
(1) PBC is not considered
(1a) AMA negative
(1b) failure to workup for PBC
(2) the cause of the liver disease is misdiagnosed (initial cause subsequently excluded)
(2a) as drug-induced hepatitis
(2b) as viral hepatitis based on antiviral antibodies
(2c) as gallbladder disease
(3) there is an overlap syndrome with autoimmune hepatitis
Differential diagnosis:
(1) incidental diagnosis of PBC: The person can have another type of hepatitis (drug, virus, other). PBC may be found during the workup for that disorder.
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