The Identification of Two New ABCB11 Gene Mutations and the Treatment Outcome in a Young Adult with Benign Recurrent Intrahepatic Cholestasis: A Case Report

Abstract

Introduction: Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive disease characterized by recurrent episodes of severe pruritus and jaundice. Although the disease symptom will relieve spontaneously without leaving any hepatic injury, the ceaseless attacks would reduce the life quality of patients. However, there is not a validated treatment for BRIC yet. Considering the limited cases and the unpredictability of this disease, the publications of well-described case reports are necessary for the investigation of disease development and treatment efficacy.Case Presentation: A 26-year-old Chinese male, with clinical approved and genetic diagnosis of BRIC, experienced 3 attacks of recurrent intrahepatic cholestasis from 2010 to 2016. During hospitalizations, he received symptomatic treatments and plasmapheresis therapies. Both plasma exchange (PE) and plasma bilirubin adsorption (PBA) were conducted for him. The whole-exome sequencing revealed several single nucleotide polymorphisms (SNPs) as well as 2 novel mutations in ABCB11 (c.70A > T, p.Lys24*, exon2 and c.1417G > A, p.Asp473Asn, exon13). These SNPs and mutations might be associated with the BRIC development. Conclusions:Both medications and plasmapheresis interventions could relieve the patient's symptoms, however, neither could shorten the natural process of the disease. The 2 mutations (c.70A > T and c.1417G > A) in ABCB11 were first reported in a BRIC patient.

Role of biopsy in Benign recurrent intrahepatic cholestasis

“…Age at first presentation is usually seen within first two decades of life 7 . Symptomatic episode may last for days to weeks and may occur once in every month or once in a decade 5,7 . Frequency of attacks decreases with age 7 .…”

“…Symptomatic episode may last for days to weeks and may occur once in every month or once in a decade 5,7 . Frequency of attacks decreases with age 7 .…”

“…There are 3 types of BRIC -1, 2 and 3 7,8 . BRIC 1 and 2 are autosomal recessive disorders whereas BRIC 3 is an autosomal dominant disorder 7 .…”

“…There are 3 types of BRIC -1, 2 and 3 7,8 . BRIC 1 and 2 are autosomal recessive disorders whereas BRIC 3 is an autosomal dominant disorder 7 . Progressive Familial Intrahepatic Cholestasis (PFIC) and BRIC represent two extreme ends of the spectrum of following mutational disorders 7,8 .…”

“…BRIC 1 and 2 are autosomal recessive disorders whereas BRIC 3 is an autosomal dominant disorder 7 . Progressive Familial Intrahepatic Cholestasis (PFIC) and BRIC represent two extreme ends of the spectrum of following mutational disorders 7,8 . Missense mutations leading to partial functional deficiency of FIC1 and BSEP occur in 50% cases of BRIC 7 .…”