Is Primary Biliary Cirrhosis a Rare Cause of Eosinophilia? A Case Report.

INTRODUCTION: Evaluation of eosinophilia involves various medical sybspecialties and the list of diseases, syndromes and inflammatory processes associated with peripheral blood (>300 eosinophils/mm³) and/or tissue eosinophilia, is quite extensive. Little attention, however, has been given to its possible association with primary biliary cirrhosis (PBC).

AIMS & METHODS: To identify PBC as a rare cause of eosinophilia

RESULTS: A 59 female patient, complaining of fatigue, referred to us for abnormal liver function tests. She had no prior history of liver disease, alcohol abuse or medication use. The haematological parameters were normal except for eosinophilia: WBC: 7.5 x 10⁹ /lit, eosinophils 1125/mm³ -15% (normal range: 3–5%) and the biochemical abnormalities included an alkaline phosphatase (ALP) of 314 U/L, γ-gt 146 U/L, total bilirubin 2.2 mg/dl (direct 1.6 mg/dl), AST 62 U/L, ALT 88 U/L and cholesterol 302 mg/dl. Eosinophilia was first detected during an initial evaluation for fatigue 20 months before. She had shown a normal serum biochemistry and negative stool examinations for intestinal parasites and ova at that time. Other causes of eosinophilia, such as skin, allergic, pulmonary, collagen, vascular or immunodeficiency disorders and malignancies, had been excluded by history, physical examination, imaging procedures (chest X-ray and abdominal CT scan) and laboratory investigation, including serum protein electrophoresis, quantitative immunoglobulins, serum immunoelectrophoresis, tumor markers and bone marrow aspirate. On admission, both abdominal and ultrasonography examination revealed a mild hepatomegaly. AMA were detected and liver biopsy was performed. After the serological and histological identification of PBC, ursodeoxycholic acid (15 mg/kg daily) was administered. Three months later, her haematological and biochemical profiles were improved (eosinophils 6%, ALP 234 U/L, γ-gt 80 U/L, AST 59 U/L, ALT 72 U/L)

CONCLUSIONS: Our case suggests that primary biliary cirrhosis should be contemplated in the differential diagnosis of eosinophilia, when all common causes are excluded. In particular, clinicians should evaluate AMA in cases of otherwise unexplained eosinophilia, even in the absence of symptoms or laboratory findings compatible to PBC.