Primary biliary cholangitis, historically known as primary biliary cirrhosis, occurs most commonly in women with female to male ratio of 9-10:1. Due to its rarity in men, it is commonly missed. We are presenting a case of an elderly man complaining of generalized pruritus. He was found to have elevated serum alkaline phosphatase activity and work up revealed primary biliary cholangitis. This case highlights the importance of workup for chronic liver disease as the elevated serum alkaline activity may be mistakenly attributed to bone, especially in geriatric population.