Benign Recurrent Intrahepatic Cholestasis (BRIC) Case Series
DOI:
https://doi.org/10.63682/jns.v14i32S.8567Keywords:
Benign Recurrent Intrahepatic Cholestasis (BRIC), Cholestatic jaundice, Recurrent jaundice, Ursodeoxycholic acid, Pruritus, Liver biopsy, Intrahepatic cholestasis, ATP8B1 mutation, Canalicular cholestasis, non-cirrhotic liver diseaseAbstract
Background: Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive hepatic disorder characterized by intermittent episodes of cholestatic jaundice, pruritus, and fatigue. Despite alarming biochemical derangements, BRIC does not lead to cirrhosis or chronic liver failure. Due to its self-limiting nature and rarity, it is often underdiagnosed, particularly in developing countries.
Aims: To describe the clinical presentation, laboratory features, imaging, histopathological findings, and therapeutic outcomes in five histologically confirmed cases of BRIC and raise awareness of this underrecognized entity.
Methods:A retrospective case series was conducted at a tertiary care centre in Belagavi, India. Five patients diagnosed with BRIC between 2021 to 2024 were studied. Data were obtained from the Department of Gastroenterology and Medical Records, including demographics, symptoms, liver function tests, imaging (USG and MRCP), histopathology, treatment, and outcomes.
Results:All five patients (4 males, 1 female; age range: 14–24 years) presented with recurrent episodes of jaundice and pruritus. Liver function tests consistently showed cholestatic patterns with elevated direct bilirubin and alkaline phosphatase, and relatively preserved transaminases. Viral, autoimmune, and metabolic causes were excluded. Imaging (USG and MRCP) revealed no biliary obstruction or architectural liver damage. Liver biopsy demonstrated canalicular and intrahepatic cholestasis. All patients responded well to supportive management, including ursodeoxycholic acid and cholestyramine, with resolution of symptoms.
Discussion:BRIC, while benign, can cause significant distress due to recurrent jaundice and itching. The episodic nature, lack of imaging findings, and histology-driven diagnosis necessitate a high index of suspicion. In our series, patients responded favourably to conservative management without long-term complications or disease progression.
Conclusion:BRIC should be considered in young patients presenting with episodic cholestatic jaundice and normal imaging findings. Prompt diagnosis through histopathological confirmation avoids unnecessary interventions. Long-term outcomes are excellent with appropriate symptomatic management and patient counselling
Downloads
Metrics
References
Bansal R, Patel A, Singh C, N C K, Saxena S. Recurrent Jaundice Unraveled: A Case of Benign Recurrent Intrahepatic Cholestasis (BRIC) in an Indian Patient. Cureus. 2024 Nov;16(11):e74736.
Luketic VA, Shiffman ML. BENIGN RECURRENT INTRAHEPATIC CHOLESTASIS. Clin Liver Dis. 1999 Aug 1;3(3):509–28.
Agarwal K, Rai P, Kumar P, et al. Benign recurrent intrahepatic cholestasis – case series. J Clin Exp Hepatol 2024;14.
Grant LM, John S. Cholestatic jaundice. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
Kumar P, Charaniya R, Ahuja A, Mittal S, Sahoo R. Benign Recurrent Intrahepatic Cholestasis in a Young Adult. J Clin Diagn Res JCDR. 2016 Jun;10(6):OD01–2.
Castaldo G, Staiano A. Benign recurrent intrahepatic cholestasis: where are we now? Medicines 2025;15(1):11.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
