Published online Apr 27, 2023. doi: 10.4254/wjh.v15.i4.577
Peer-review started: January 24, 2023
First decision: March 6, 2023
Revised: March 9, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: April 27, 2023
Only a few cases of chronic hepatitis B (CHB) with primary biliary cholangitis (PBC) have been reported based on histological evidence from liver biopsies.
To observe the clinicopathological features and outcomes of 11 patients with CHB infection complicated by PBC.
Eleven patients with CHB and PBC who underwent liver biopsy at the Zhenjiang Third Hospital, affiliated with Jiangsu University, and Wuxi Fifth People’s Hospital, from January 2005 to September 2020, were selected. All patients initia
Only five had elevated alkaline phosphatase levels, nine were positive for anti-mitochondrial antibody (AMA)-M2, and two were negative for AMA-M2. Two had jaundice and pruritus symptoms, 10 had mildly abnormal liver function, and one had severely elevated bilirubin and liver enzyme levels. The pathological characteristics of CHB complicated by PBC overlapped with those of PBC-autoimmune hepatitis (AIH). When necroinflammation of the portal area is not obvious, the pathological features of PBC are predominant, similar to the features of PBC alone. When the interface is severe, biliangitis will occur, with a large number of ductular reactions in zone 3. Unlike the PBC-AIH overlap pathology, this pathology is characterized by a small amount of plasma cell infiltration. Unlike PBC, lobulitis is often observed.
This is the first large case series to show that the rare pathological features of CHB with PBC are similar to those of PBC-AIH and small duct injury was observed.
Core Tip: We retrospectively observed the clinicopathological features and outcomes of 11 patients with chronic hepatitis B (CHB) infection complicated by primary biliary cholangitis (PBC). We found that CHB complicated with PBC had pathological characteristics overlapping with PBC-autoimmune hepatitis. When necroinflammation of the portal area is not obvious, the pathological features of PBC are superior, similar to the features of PBC alone, this pathology is characterized by a small amount of plasma cell infiltration. Unlike PBC alone, lobulitis is often present. All patients improved after antiviral and ursodeoxycholic acid treatment and stabilized after 1 year.