Primary Biliary Cholangitis With Pulmonary Manifestations and Concurrent Enterococcus Pneumonia: A Diagnostic Challenge Resembling Sarcoidosis or Silicosis

Primary biliary cholangitis (PBC) is common in females during middle age, presenting with fatigue and itching. In our case, an African-American male patient presented with abdominal pain, vomiting, fatigue, and lung manifestations such as interstitial lung disease, granulomatous lung disease, and pu...

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Published in:Curēus (Palo Alto, CA) CA), 2024-04, Vol.16 (4), p.e59160
Main Authors: Al-Ghuraibawi, Muthanna Mohammed Hasan, Neravanda Prasad, Parinitha, Gupta, Uma, Roy, Pulok, Hlaing, Pwint Phyu
Format: Article
Language:English
Subjects:
Abdomen
Anemia
Antibodies
Antigens
Bronchoscopy
Cholangitis
Critical care
Gastroenterology
Glucose
Hemoglobin
Internal Medicine
Kidneys
Lavage
Leukocytes
Liver
Medical diagnosis
Patients
Phosphatase
Pneumonia
Pulmonology
Sarcoidosis
Silicosis
Tomography
Urine
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Summary:Primary biliary cholangitis (PBC) is common in females during middle age, presenting with fatigue and itching. In our case, an African-American male patient presented with abdominal pain, vomiting, fatigue, and lung manifestations such as interstitial lung disease, granulomatous lung disease, and pulmonary hypertension. In our case, the patient reported abdominal pain and fatigue with abnormal chest X-ray findings (bilateral pulmonic nodular lesion with calcifications), which mimicked silicosis/sarcoidosis lung findings such as bronchiectasis and parenchymal nodules. We diagnosed PBC as there was an absence of extrahepatic biliary obstruction and the presence of antimitochondrial antibodies (AMA) at a titer of 1:40 or higher. Bronchoalveolar lavage was performed due to the suspicion of interstitial lung disease and sarcoidosis, which was inconclusive but revealed enterococcus faecalis organisms. Initial antibiotic response heightens suspicion of infection, not colonization, leading to the diagnosis of enterococcal pneumonia. In our case, the diagnosis was made using clinical and laboratory criteria, and treatment with Ursodeoxycholic acid was opted for without resorting to more expensive and invasive tests like magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). In summary, this case report presented the unique diagnostic challenges that will aid clinicians in considering a broad range of differential diagnoses and management plans.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.59160