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Tuberculosis Research and Treatment
Volume 2012 (2012), Article ID 218183, 10 pages
Review Article

Tuberculosis Is Not a Risk Factor for Primary Biliary Cirrhosis: A Review of the Literature

1Institute of Liver Studies, King’s College Hospital and Division of Transplantation Immunology and Mucosal Biology, School of Medicine, King’s College London, London SE5 9RS, UK
2Cellular Immunotherapy and Molecular Immunodiagnostics, Center for Research and Technology Thessaly, 41222 Larissa, Greece
3Department of Medicine, University Hospital of Larissa, University of Thessaly School of Medicine, 41110 Larissa, Greece
4Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, University of Barcelona, 08036 Barcelona, Spain
5Faculty of Veterinary Science, University of Thessaly, 43100 Karditsa, Greece
6The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and Department of Surgery, University Collegue London, London NW32QG, UK

Received 20 July 2012; Accepted 3 October 2012

Academic Editor: Juraj Ivanyi

Copyright © 2012 Daniel S. Smyk 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.


Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterised serologically by cholestasis and the presence of high-titre antimitochondrial antibodies, and histologically by chronic nonsuppurative cholangitis and granulomata. As PBC is a granulomatous disease and Mycobacterium tuberculosis is the most frequent cause of granulomata, a causal relation between tuberculosis and PBC has been suggested. Attempts to find serological evidence of PBC-specific autoantibodies such as AMA have been made and, conversely, granulomatous livers from patients with PBC have been investigated for molecular evidence of Mycobacterium tuberculosis. This paper discusses in detail the reported data in support or against an association between Mycobacterium tuberculosis infection and PBC. We discuss the immunological and microbiological data exploring the association of PBC with exposure to Mycobacterium tuberculosis. We also discuss the findings of large epidemiologic studies investigating the association of PBC with preexistent or concomitant disorders and the relevance of these findings with tuberculosis. Genome-wide association studies in patients with tuberculosis as well as in patients with PBC provide conclusive hints regarding the assumed association between exposure to this mycobacterium and the induction of PBC. Analysis of these data suggest that Mycobacterium tuberculosis is an unlikely infectious trigger of PBC.