35, normal range 7-56 UI/L), high serum alkaline phosphatase (ALP) level (598, normal range 100-240 UI/ L) and high gamma glutamyl transpeptidase (GGT) level (312, normal range 5-30 UI/L). Hepatitis A, B, and C virus were excluded. These serum alterations indicated the need for an abdominal ultrasound, which showed hepatosteatosis without biliary tract dilatation and normal spleen volume. The patient was discharged, and follow-up was provided in an outpatient clinic.The patient was rehospitalized in February 2008, with itching and fatigue lasting for 2 months. On physical examination, the patient showed hyperpigmentation, dermatographism, and xerosis of skin. No symptoms or signs for congestive heart failure were detected. Laboratory tests showed high concentrations of GGT (1,048 UI/L), ALP (1,672 UI/L), ALT (104 UI/L), and AST (64 UI/L). Bilirubin values were normal (0.72 mg/dL), and creatinine levels were high (2.3, normal value 0.5-0.9 mg/dL). An abdominal ultrasound confirmed previous results, and magnetic resonance imaging was normal. Suspecting PBC, antimitochondrial and antinuclear antibodies were measured and found to be positive. Esophageal varices were highlighted using esophagogastroduodenoscopy, and the presence of dry eyes was confirmed according to breakup time and Shirmer tests. The diagnosis of PBC was confirmed. Percutaneous liver biopsy was not performed because the patient was older than 75. 8 Treatment was started with ursodeoxycholic acid and cholestyramine to reduce cholestasis-associated pruritus and to improve quality of life.This case highlights the possible occurrence of PBC in older men with persistent cholestasis, pruritus, and fatigue; symptoms not explained by other possible diagnoses have led to detection of PBC.In conclusion, in elderly patients, who frequently have common diseases, rare diseases must also be taken into consideration to provide the best medical care.