Primary Biliary Cholangitis with Normal Alkaline Phosphatase Level: Clinical Case and Literature Review

Abstract

Antimitochondrial autoantibodies of the M2 subclass (AMA-M2) in primary biliary cholangitis (PBCh) under conditions of cholestasis are considered as one of the main criteria for diagnosis that does not require morphological confirmation. However, the detection of AMA-M2 in asymptomatic patients causes ambiguity of interpretation. Along with the assumption that such patients may have preclinical stage of PBCh, there is an opinion about the "healthy carrier" of AMA-M2. The article presents the clinical observation of a patient with the high AMA-M2 titer without significant clinical manifestations, the normal level of alkaline phosphatase, with changes in liver tissue characteristic of PBCh, revealed by the results of histological examination. Clinical observation demonstrates the need for liver biopsy for early detection of PBCh in AMA-M2-positive patients belonging to the risk group