<prompt> Commonest presentation of primary biliary cirrhosisPruritusPainJaundiceFever  <response>: Primary biliary cirrhosis Believed to be an autoimmune etiology, leading to progressive destruction of intrahepatic bile ducts More common in females Associated with autoimmune disorders CREST, Sicca syndrome, Autoimmune thyroiditis, Renal tubular acidosis Clinical features Most patients are asymptomatic, pruritus the commonest and earliest symptom. Pruritus precedes jaundice in PBC, Pruritus is most bothersome in evening Jaundice, fatigue, melanosis gradual darkening of exposed areas of skin, deficiency of aft soluble vitamins due to malabsorption Xanthomas and xanthelesmas due to protracted elevation of serum lipids Ref: Sabiston 20th edition Pgno : 639 