Cholestasis, Chronic Pruritus and Hepatitis C -the Importance of the Differential Diagnosis Should Not Be Underestimated

Chronic pruritus appears the most frequently in dermatological conditions but it can also be present in liver disease. Primary biliary cirrhosis (PBC, or also known as primary biliary cholangitis) or primary sclerosing cholangitis (PSC) are liver diseases which are manifesting with the appearance of cholestasis: high levels of alkaline phosphatase (ALP) and/or gamma -glutamyl transferase (GGT). Clinically, cholestasis causes chronic pruritus. In some cases, cholestasis syndrome and chronic pruritus may also occur in viral hepatitis C. The purpose of this paper is to present the case of a female patient who presented with chronic pruritus and fatigue and later we diagnosed her with hepatitis C. Physical examination showed only scrachings and a liver with 3 cm below the right costal rim but laboratory tests evidenced a cholestasis syndrome and a hepatocytolysis syndrome. Knowing from the literature that the occurrence of cholestasis concomitantly with chronic pruritus are characteristic manifestations of cholestatic liver disease (PBC, PSC) with a prevalence of about 80%, so we tested the patient on antimitochondrial antibodies (AMA) for PBC and pANCA for PSC with negative results. We continued the investigations and found that the patient had hepatitis C with positive anti – HCV antibodies. It was very interesting to see that on the hepatoprotective treatment, cholestasis syndrome and hepatocytolysis syndrome also improved.