Clinical Misdiagnosis of Primary Biliary Cirrhosis with Pruritus as the Ini-tial Symptom

XU Guangchao; AN Song; TANG Xiaohui; SUN Qian; SUN Xueshan; SUN Lina; WU Jing

doi:10.3969/j.issn.1002-3429.2024.10.003

Abstract：Objective To analyze the causes and preventive measures of early misdiagnosis in patients with primary biliary cirrhosis(PBC)with pruritus as the initial symptom.Methods From May 2022 to November 2023,PBC patients who had been initially misdiagnosed as pruritus with pruritus as the initial symptom were selected,and their clinical data were ana-lyzed.Results Among the 3 patients,2 were middle-aged and elderly women and 1 was middle-aged man.All of them pres-ented with pruritus as the initial symptom,accompanied by general fatigue.Liver function was not detected in all of them.The initial diagnosis was skin pruritus,which did not show significant improvement after symptomatic treatment.After detailed physical examination,multiple liver function tests,abdominal color ultrasound and/or liver CT,and serum anti-mitochondrial antibody(AMA)positive test,PBC was confirmed.The misdiagnosis lasted from 13 d to 4.5 years.After diagnosis,they were treated with Ursodeoxycholic Acid and other drugs,liver function returned to normal,and symptoms improved or disap-peared.Conclusion The early symptoms of PBC are often atypical.When the patients present with pruritus as the main symptom accompanied by fatigue,jaundice and no or mild liver function injury,the changes of liver function indexes should be dynamically observed repeatedly,and serum AMA detection should be performed,as well as liver puncture pathology when necessary,to confirm the diagnosis.In addition,the attending doctors should strengthen the understanding of the disease,be familiar with the cause of liver function injury,perform careful identification and physical examination,especially should pay attention to the possibility of male patients developing the disease,and improve vigilance.