Introduction We report an unusual presentation of primary biliary cirrhosis. Case presentation We present the case of a 66-year-old white British woman who presented to the Accident and Emergency department with ascites and unilateral pleural effusion (hepatic hydrothorax). Following a liver biopsy, the diagnosis of primary biliary cirrhosis was made. Conclusion It is important to consider the diagnosis of hepatic cirrhosis when presented with a unilateral pleural effusion in both the presence and absence of ascites.
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