An 83-year-old woman who was admitted to an emergency department for unsteadiness and dizziness was eventually diagnosed with primary biliary cirrhosis (PBC), according to a case report by Patrice Baptiste, MBBS, and F. Akinshipo.
Although admitted for unsteadiness, the patient denied falling over, loss of consciousness, chest pain, palpitations, and shortness of breath. Background conditions included hypertension, hypercholesterolemia, atrial fibrillation, a transient ischemic attack, varicose veins, and tinnitus. There was nothing significant in family history, and the patient was an occasional drinker but had never smoked.
An additional review of symptoms before investigation began found coryzal symptoms, dysuria, urinary frequency, and pruritus. After an initial investigation, viral hepatitis was suspected, but additional investigations and a series of negative test results for viral hepatitis led to a diagnosis of PBC. The patient was prescribed ursodeoxycholic acid and discharged from the emergency department.
“There were little findings in this patient’s presentation to suggest PBC; the revelation of pruritus was the only clue before the investigations were conducted,” the investigators wrote. “It is well known that patients can present with nonspecific symptoms or no symptoms at all. Therefore, PBC is an important differential to consider in elderly patients, especially when we know a large proportion of over 65-year-olds are diagnosed with PBC.”
Find the full case report in European Geriatric Medicine (2016 Mar 31. doi: 10.1016/j.eurger.2016.03.002).