A 45-year-old woman presents to her primary care physician with jaundice, pruritus, and periocular and intra digital xanthomas. Her laboratory results indicate a significantly increased alkaline phosphatase as well as a positive test for antimitochondrial antibodies. The most likely cause of her symptoms is

Primary biliary cirrhosis Autoimmune condition that typically presents in middle-aged women and with anti-mitochondrial antibodies. The itching and hypercholesterolemia are secondary to severe obstructive jaundice. Leptospirosis is a condition caused by a treponemal bacterium that results in jaundice, renal failure, Macronodular cirrhosis is usually a result of hepatitis B or hepatitis C infection. Primary sclerosing cholangitis is associated with ulcerative colitis and with an increased incidence of cholangiocarcinoma.