Given the patient’s background of PBC and autoimmune hepatitis with elevated ammonia levels, we suspected hepatic encephalopathy, although the serum liver function tests were within normal ranges: aspartate aminotransferase (AST), 63 U/L; alanine aminotransferase (ALT), 92 U/L; and total-bilirubin (T-Bil), 1.25 mg/dL. This evidence concerns the gene GPT and primary biliary cholangitis.