Primary Sclerosing Cholangitis

We present a case of a 47-year-old woman with non-specific symptoms and signs of anaemia. Her liver function tests were abnormal and Anti-Nuclear Antibodies (ANA) was significantly elevated. Magnetic Resonance Cholangio- Pancreaticography (MRCP) revealed multiple strictures of intrahepatic ducts and colonoscopy revealed mucosal inflammation and polyps. Imaging-guided liver biopsy was also performed and the findings were compatible with Primary Sclerosing Cholangitis (PSC) with ulcerative colitis. Patient was treated for anaemia and appropriate drugs were prescribed for the auto-immune condition. Prevalence of PSC is very rare in Singapore. It is characterized primarily by inflammation and fibrosis of the biliary tree. It is associated with inflammatory bowel disease and a host of other conditions, eventually leading to cirrhosis and death. Diagnosis is achieved by imaging, laboratory markers and histology. ERCP is the current gold standard investigation, although MRCP is the noninvasive investigation of choice. Early diagnosis and medical intervention slow the disease progression and decrease mortality and morbidity.