RECURRENT ARTHRITIS, ERYTHEMA-NODOSUM AND CARDIAC-ARRHYTHMIAS AS UNUSUAL SIGNS OF PRIMARY BILIARY-CIRRHOSIS

History and admission findings: A 42-year-old woman, with recurrent ar thritis of the large joints and erythema nodosum for 7 years, was admi tted because of recent onset of bouts of rapid heart rate. A 2/6 systo lic murmur at Erb's point was the only contributory finding on physica l examination. Investigations: The transaminases and gamma-GT were ele vated, as were total cholesterol, LDL fraction, IgM, total protein, ga mma-globulin and IgM, Antimitochondrial antibodies, especially anti-M- 2, were positive, while rheumatoid factor and C-reactive protein were negative. AMA, ANCA and antibodies against double-strand DNA were not: demonstrated. ENA screening was negative. Abdominal computed tomograp hy showed discrete intrahepatic cholestasis. Liver biopsy revealed chr onic destructive cholangitis, i.e. the early stage of primary biliary cirrhosis. Treatment and course: On treatment with ursodeoxycholic aci d (10 mg/kg daily) the patient has remained free of symptoms for 3 yea rs and laboratory tests no longer showed evidence of impaired liver fu nction. Conclusion: Primary biliary cirrhosis should be included in th e differential diagnosis of recurrent arthritis and erythema nodosum, as early treatment with ursodeoxycholic acid can favourably influence its course.