"Case Report: Primary Sclerosing Cholangitis (PSC) Manifestation During Pregnancy Complicated by Liver Cirrhosis"

Abstract

Background: Liver disease imposes a considerable risk to both the mother and the fetus during pregnancy and may develop inadvertently during pregnancy. Primary sclerosing cholangitis (PSC) is a rare cause of liver disease in pregnancy. PSC is an uncommon chronic cholestatic liver disease characterized by inflammatory damage of the intrahepatic and/or extrahepatic bile ducts, which results in bile stasis, fibrosis, and ultimately cirrhosis.

 Case Description: We present here a unique case of PSC that was diagnosed 2 months postpartum as the patient presented to the gastroenterology clinic with pruritis that did not subside after delivery. Clinical observations noted a jaundiced appearance and underweight status. Laboratory investigations also revealed elevated enzyme levels. Serology tests for hepatitis and the human immunodeficiency virus returned negative results. Magnetic resonance cholangiopancreatography imaging revealed an enlarged liver with intrahepatic biliary dilatation and strictures, accompanied by multiple varices and splenomegaly, indicative of primary sclerosing cholangitis with early cirrhotic changes. This confirmed the diagnosis of PSC complicated by liver cirrhosis. The patient was effectively managed with ursodeoxycholic acid at a dosage of 250mg orally three times a day and mesalazine at 1g three times a day; however, due to the cirrhotic stage, the patient was additionally referred to a transplantation facility.

Conclusion: In pregnancy, as a body undergoes various physiological and hormonal changes, pregnant patients may present with symptoms of liver diseases, which normally subside after delivery. However, diagnosis and occurrence of PSC during pregnancy is quite rare but cannot be ignored. Therefore, critical attention shall be paid to pregnant women who report any fluctuations in liver enzymatic levels or complain of pruritis, as late diagnosis can lead to severe complications and maternal and fetal mortality.