Case 4-2023: A 56-Year-Old Man with Abnormal Results on Liver Testing

This case examines a 56-year-old man with a history of alcohol and opioid use who presented with abnormal liver test results, pancytopenia, portal vein thrombosis, splenomegaly, and hepatic nodularity. Laboratory testing revealed a markedly cholestatic liver profile and high-titer antimitochondrial antibodies. Liver biopsy confirmed primary biliary cholangitis without cirrhosis but with evidence of ductopenia, portal inflammation, and mild nodular regenerative hyperplasia. The patient also had portopulmonary hypertension requiring pulmonary vasodilators prior to consideration for liver transplantation. This case illustrates a complex interplay of autoimmune liver disease, presinusoidal portal hypertension, and cardiopulmonary complications.

This case examines a 56-year-old man with a history of alcohol and opioid use who presented with abnormal liver test results, pancytopenia, portal vein thrombosis, splenomegaly, and hepatic nodularity. Laboratory testing revealed a markedly cholestatic liver profile and high-titer antimitochondrial antibodies. Liver biopsy confirmed primary biliary cholangitis without cirrhosis but with evidence of ductopenia, portal inflammation, and mild nodular regenerative hyperplasia. The patient also had portopulmonary hypertension requiring pulmonary vasodilators prior to consideration for liver transplantation. This case illustrates a complex interplay of autoimmune liver disease, presinusoidal portal hypertension, and cardiopulmonary complications.