Beyond serology: Leveraging radiological and pathological tools in seronegative primary biliary cholangitis

Primary biliary cholangitis is a chronic autoimmune inflammatory disease that affects the bile ducts, presenting a broad clinical spectrum characterized by cholestasis and the presence of antimitochondrial antibodies. This report describes the case of a young adult presenting with fever, musculoskeletal pain, and altered bowel habits, alongside markers of hepatocellular damage with a cholestatic pattern, but with negative antimitochondrial and antinuclear antibodies. A liver biopsy revealed findings consistent with cholangitis. This case underscores the importance of considering cholangitis in the differential diagnosis of patients with abnormal liver biochemistry tests showing a cholestatic pattern, even in the absence of specific immune serological markers.