•Primary Biliary Cirrhosis is a not uncommon cause of
chronic liver disease
especially in women
•
•Presents with fatigue and skin itching without jaundice
•
•Tests reveal raised alkaline phosphatase
•
•Studied 18 PBC patients 14 with early pre-cirrhotic
•
•Blood manganese elevated - reduced ability to excrete
excess
•
•Accumulation of mineral in the brain (reduced
magnetisation transfer
ratio in the globus pallidus) similar to industrial manganese excess, which causes Parkinsonism
•
•Similar changes may occur in infants with biliary
atresia
•
•Manganese accumulation can easily occur in
those with
cholestasis or raised alkaline phosphatase level
•
•Reference: Fotron DM et al. Gut 2004;53:587-592.
Fatigue and primary
biliary cirrhosis: association of globus pallidus magnestisation transfer ratio measurements with fatigue severity and
blood manganese levels.