A sporadic case of benign recurrent intrahepatic cholestasis in a growth-impaired young male

Abstract

Benign recurrent intrahepatic cholestasis (BRIC) is a rare genetic liver disorder characterized by recurrent episodes of jaundice and severe pruritus without significant liver damage. Here, we present the case of a man in his early 20s, standing 143 cm tall, who has experienced recurrent jaundice and pruritus over an 18-year period. Laboratory investigations and liver biopsy examination indicated typical intrahepatic cholestasis with normal gamma-glutamyl transpeptidase levels, excluding viral, metabolic, and autoimmune causes. Further genetic analysis confirmed the diagnosis of BRIC with two compound heterozygous mutations in ATP8B1 gene on chromosome 18: NM_001374385.1: c.2081T > C p. (Ile694Thr) (rs541474497) in exon 18 and NC_000018.10 (NM_001374385.1): c.1631-2A > G in intron 15. To our knowledge, the latter has not been reported. Family lineage analysis and Sanger sequencing showed that these mutations were de novo rather than hereditary. Treatment with ursodeoxycholic acid and cholestyramine resulted in complete resolution of jaundice and pruritus, with normalization of serum bilirubin level after six months of therapy.

Keywords: Benign recurrent intrahepatic cholestasis; case report; growth impairment; jaundice; osteoporosis.

Figure 1.

(a) and (b) The patient's body height of 143 cm, and yellow skin and sclera, respectively; (c) liver histology showed lobular structure remains intact (hematoxylin and eosin stain × 100), (d) bile plugs, mild hepatic plate swelling, diffuse hydropic degeneration of hepatocytes, and minor fibrous connective tissue were also observed (hematoxylin and eosin stain × 400).