The serum immunoglobulin-G (IgG) level was 23 (normal 5.4-16.1). The serum copper, ceruloplasmin, 24 hour urine copper, serum iron and transferrin saturation were all normal. Ultrasound abdomen and MRCP were normal. Liver biopsy showed evidence of interphase hepatitis stage 3/6, with focal intrabiliary steatosis and mild intra cellular cholestasis.

The histological activity index was 5/18. She started treatment with prednisolone (60 mg daily) and UDCA (250 daily); nevertheless, for over 6 month she did not show any improvement of the symptoms or liver enzymes profile (maintaining normal to 1.5 times normal ALT and AST) but continued to have buy CX-5461 progressive cholestasis (Figure 1). Over the Selleck GSK872 next 6 months of follow up, the symptomatology worsed. She developed moderate ascites that progressed to diuretic refractory ascites over a few months, recurrent bacterial peritonitis and 4 attacks of stage III-IV hepatic encephalopathy. Prednisolone was tapered down, and then stopped; finally, she was selected for liver transplantation, however she died while in the waiting list. Figure 1 Results of the serum alkaline phosphatase (Alk phos) and bilirubin levels (T Bil) for the first two patients during the follow-up. Second patient The

second patient was a 30-year-old male, a Saudi security officer, who presented a history of progressive jaundice for 2 years. He had unremarkable past history, denying drug or alcohol abuse, and medications, including herbal medicines. There was no family history of liver disease or history of contact with jaundiced patients. His physical examination showed normal vital signs. He had deep jaundice,

but the rest of the general examination was normal. The chest, the cardiovascular, and the abdominal examinations were normal. His baseline workup showed CBC (WBC 8.4 k/μl, Hg11.5 g/l, Plat 373), LFT (AST 531 U/L, ALT 250 U/L, ALP 682 U/L, GGT 205 U/L, TBil 344, Direct Bil 278, albumin 17, total protein 80), PT 13.3, and the renal functions were normal. The ultrasound examination of the abdomen showed hepatomegaly, but there were no evidence Neratinib research buy of biliary obstruction. The ANA, SMA, AMA, LKM-1, HBV serology, HCV serology and the HIV testing were all negative. The serum IgG level was 25. Testing for Wilson’s disease, by serum copper, ceruloplasmin and 24 hours urine copper, revealed normal results. Similarly, the serum iron and the total iron binding capacity (TIBC) and the transferrin saturation were normal. He had MRCP that showed a normal biliary system cholangiography. A liver biopsy was performed and it detected marked sinusoidal dilatation, infiltration of the biliary tracts with chronic inflammatory cells (mostly lymphocytes and some CB-839 in vitro plasma cells), associated with bile duct damage. There was also chronic inflammatory cell infiltration of the hepatic lobules. The hepatocytes showed cholestasis.