PT  - JOURNAL ARTICLE
AU  - Nneoma Kate-Joan Onuorah
AU  - Melinda Wayde
AU  - Gregory Beck
TI  - Unusual presentation of pica in iron-deficiency anaemia associated with primary biliary cholangitis
AID  - 10.1136/bcr-2018-227316
DP  - 2019 May 01
TA  - BMJ Case Reports
PG  - e227316
VI  - 12
IP  - 5
4099  - http://casereports.bmj.com/content/12/5/e227316.short
4100  - http://casereports.bmj.com/content/12/5/e227316.full
SO  - BMJ Case Reports2019 May 01; 12
AB  - A 50-year-old woman presented with worsening fatigue and shortness of breath. For 2 months, she has been having increased craving for unpeeled lemons and was seen in clinic about a month prior to presentation at the emergency room. At that time, she was asymptomatic except for endorsing craving for lemons. Physical exam findings at presentation noted obesity, sinus tachycardia, pallor, mild scleral jaundice and no other stigmata for chronic liver disease. Her labs suggested iron-deficiency anaemia (IDA), elevated liver enzymes and positive antimitochondrial antibody titre. Abdominal ultrasound and CT scan showed mild scarring. She was diagnosed with primary biliary cholangitis with portal hypertension complicated by oesophageal varices and IDA. Interventions included blood transfusion, oesophageal banding and treatment with ursodeoxycholic acid. Her craving for lemons, shortness of breath and fatigue resolved within 1 week. With ongoing outpatient follow-up and oesophageal variceal surveillance, she continues to do well.