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Gastroenterology Research and Practice
Volume 2010 (2010), Article ID 121620, 4 pages
http://dx.doi.org/10.1155/2010/121620
Clinical Study

Early Primary Biliary Cirrhosis: A New Association with Erythema Nodosum of Unknown Origin

1Department of Medicine, School of Medicine, University of Thessaly, Thessaly, 41110 Larissa, Greece
2Research Group of Investigational Medicine, Institute of Biomedical Research and Technology, Centre for Research and Technology-Thessaly (CE.RE.TE.TH), 41222 Thessaly, Larissa, Greece

Received 6 April 2010; Accepted 22 June 2010

Academic Editor: Christian Trautwein

Copyright © 2010 Nikolaos K. Gatselis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary biliary cirrhosis (PBC) is associated with immune-mediated dermatologic disorders. The association of PBC with erythema nodosum (EN) seems rare. We report two females (42 and 44 years old) with low-grade fever, arthralgias, and elevated cholestatic enzymes in the first and fatigue in the second. Patients were also suffering from typical EN lesions characterized by multiple erythematous, painful nodules over the anterior portions of their lower extremities. Clinical and extensive laboratory work up excluded all known EN causes. PBC diagnosis was established according to the cholestatic biochemical profile, anti-mitochondrial antibodies (AMA) positivity and liver histology (first), and AMA and antinuclear (ANA) PBC-specific antibodies (second). Our report may suggest that PBC could be kept in mind in EN patients of unknown aetiology and particularly, when middle-aged female patients are affected. In such cases a thorough evaluation for AMA and/or ANA PBC-specific antibodies could be helpful to achieve a correct and timely diagnosis.