Changes in titers of antimitochondrial and antinuclear antibodies during the course of primary biliary cirrhosis

A case of primary biliary cirrhosis (PBC) in whom a complete biochemical (s erum bilirubin, transaminases and alkaline phosphatase) remission was noted after combination treatment with ursodeoxycholic acid (UDCA) and corticost eroid is reported. The antimitochondrial antibody (AMA) detected by indirec t immunofluorescence was initially positive, and the antinuclear antibody ( ANA) was negative, but these two antibodies subsequently fluctuated indepen dently (AMA-positive/ANA-negative, AMA-negative/ANA-negative, AMA-negative/ ANA-positive, AMA-positive/ANA-positive, and again AMA-negative/ANA-positiv e) in spite of a lack of histopathological improvement in the liver after t reatment. The clinical presentation in our case suggests that in some cases the diagnosis of PBC or so-called autoimmune cholangitis (AIC) might depen d on the 'phase' of the same disease. Our results also suggest that detaile d immunoreactive profiles against 2-oxo-acid dehydrogenase complex (2-OADC) enzymes by using immunoblotting, together with a serial histological exami nation, should provide more precise information for a diagnosis of PBC. (C) 2001 Blackwell Science Asia Pty Ltd.