Abstract
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by interlobular bile duct inflammation, which causes fibrosis and cirrhosis. Few studies have explored the association of hypoglycemia with PBC. In this case, a 76-year-old Chinese man diagnosed with PBC developed recurrent comatose episodes. The patient had severe hypoglycemia and slight abnormalities in liver function tests. In addition, the patient had positive results in antimitochondrial antibody, anti-mitochondrial antibody-subtype 2, centromeric protein B antibody, and antisoluble acidic nuclear protein 100 antibody levels, which led to the diagnosis of PBC. The patient also experienced fasting hypoglycemic coma, requiring thorough evaluation to identify potential causes. This case suggests that liver-derived hypoglycemia associated with PBC may be more common than autoimmune-related hypoglycemia in this context.