A 53-year-old Japanese man was found to have a liver dysfunction with a total bilirubin of 3.3 mg/dl, ALT 724 IU/l, alkaline phosphatase 568IU/l with an elevation of serum IgM while serum levels of IgG, antinuclear antibody (ANA) and anti-mitochondrial antibody (AMA) showed normal. Primary biliary cirrhosis (PBC) was suspected at that time, however, he left the hospital by self-determination. Five years later, he developed liver cirrhosis with jaundice, ascites and skin pigmentation and sclerosis. Antinuclear antibody, negative 5 years before, was now positive at 1: more than 2560. Serum IgG and IgM were elevated. Anti-mitochondrial antibody M2 component, and liver-kidney microsome (LKM)-1 antibody, double strand DNA antibody, platelet-associated IgG, direct-, indirect Coombs tests were also positive. Liver histology revealed cirrhosis. He was diagnosed as having AIH/PBC overlap syndrome due to serologic features. Sequential changes of the titers of several antibodies, laboratory characteristics and clinical symptoms within short durations are discussed.
All Science Journal Classification (ASJC) codes