Question

A 53 year old female consults her physician due to progressive itching, yellowing of her skin, and fatigue. She denies any past history of jaundice and denies ever receiving a blood transfusion or abusing alcohol. Her past medical history includes hypertension and Sjogren's syndrome. Physical examination shows prominent hepatomegaly and scattered excoriations throughout the skin. Laboratory evaluation shows an elevated bilirubin, moderately elevated transaminases, and markedly elevated alkaline phosphatase with a normal albumin. Anti-mitochondrial antibodies are positive at >1:256. Which of the following is the most likely diagnosis for this patient?

A. Hepatitis C
B. Autoimmune hepatitis
C. PSC
D. PBC
E. Pancreatic carcinoma

Answer 1

The most likely diagnosis for the patient described is Primary Biliary Cholangitis (PBC), based on her symptoms, lab results, and the presence of anti-mitochondrial antibodies.

Step-by-step explanation:

The most likely diagnosis for a 53-year-old female presenting with progressive itching, yellowing of her skin (jaundice), and fatigue, with no history of jaundice, blood transfusions, or alcohol abuse, but with a history of Sjogren's syndrome, is Primary Biliary Cholangitis (PBC).

The physical examination showing hepatomegaly and scattered excoriations, in combination with the laboratory finding of an elevated bilirubin, moderately elevated transaminases, and markedly elevated alkaline phosphatase with a normal albumin, support this conclusion. The presence of high titers of anti-mitochondrial antibodies is also a hallmark of PBC, thus further supporting this diagnosis.