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Li W, Jiang F, Li X, Li H, Zheng Z. A rare case of eosinophilic cholangiopathy. Int J Immunopathol Pharmacol 2021; 34:2058738420941752. [PMID: 32684063 PMCID: PMC7372610 DOI: 10.1177/2058738420941752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Eosinophilic cholangiopathy is termed as a rare, benign, and self-limiting
disease. Moreover, the interference of malignant tumor to diagnosis and the
changing process of disease make the accurate treatment proposal challenging. A
significant number of patients require surgery for the definitive diagnosis and
resolution of symptoms. We put forward a case of eosinophilic cholangiopathy
infiltrating the gallbladder and bile duct with bone marrow involved, coupled
with peripheral eosinophilia. The patient underwent a successful treatment using
laparoscopic cholecystectomy and steroids, instead of extrahepatic bile duct
excision with Roux-en-Y hepaticojejunostomy. The patient gets an accurate
treatment in a minimally invasive manner. In conclusion, surgery refers to not
only a diagnostic methodology but also a treatment. When the bile duct and
gallbladder are involved at the same time, and cannot distinguish benign and
malignant diseases, laparoscopic cholecystectomy is feasible, the effect is the
same, and the symptoms of eosinophilic cholecystitis are relieved.
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Affiliation(s)
- Wenya Li
- Wenzhou Medical University, Wenzhou, China
| | - Feizhao Jiang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoxiao Li
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Li
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihai Zheng
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Klindt C, Jensen B, Brandenburger T, Feldt T, Killer A, Schimmöller L, Antoch G, Senff T, Hauka S, Timm J, Bahners BH, Seidl M, Esposito I, Luedde T, Bode JG, Keitel V. Secondary sclerosing cholangitis as a complication of severe COVID-19: A case report and review of the literature. Clin Case Rep 2021; 9:e04068. [PMID: 34084492 PMCID: PMC8142800 DOI: 10.1002/ccr3.4068] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022] Open
Abstract
This case of secondary sclerosing cholangitis (SSC-CIP) emphasizes the need to provide follow-up care for patients that have recovered from COVID-19 in order to understand the complexity of SARS-CoV-2 associated sequela.
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Affiliation(s)
- Caroline Klindt
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Björn‐Erik Jensen
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Timo Brandenburger
- Department of AnaesthesiologyMedical FacultyHeinrich‐Heine UniversitätDüsseldorfGermany
| | - Torsten Feldt
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Alexander Killer
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional RadiologyHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Gerald Antoch
- Department of Diagnostic and Interventional RadiologyHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Tina Senff
- Institute of VirologyHeinrich Heine UniversityUniversity HospitalDüsseldorfGermany
| | - Sandra Hauka
- Institute of VirologyHeinrich Heine UniversityUniversity HospitalDüsseldorfGermany
| | - Jörg Timm
- Institute of VirologyHeinrich Heine UniversityUniversity HospitalDüsseldorfGermany
| | - Bahne Hendrik Bahners
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Maximilian Seidl
- Institute of PathologyHeinrich‐Heine University and University HospitalDüsseldorfGermany
| | - Irene Esposito
- Institute of PathologyHeinrich‐Heine University and University HospitalDüsseldorfGermany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Johannes G. Bode
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Verena Keitel
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
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Dodda A, Matsukuma K, Urayama S. Eosinophilic cholangitis: A case report of diagnostically challenging eosinophilic infiltrative biliary obstruction. World J Gastrointest Endosc 2019; 11:589-595. [PMID: 31839877 PMCID: PMC6885728 DOI: 10.4253/wjge.v11.i12.589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/17/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evaluation of biliary strictures primarily focuses on ruling out malignancy in older age groups. With endoscopic tools such as endoscopic ultrasound (EUS) and cholangioscopy, improved biliary visualization has enhanced the investigation of intraluminal biliary lesions and provided modalities for targeted biopsies. Benign biliary strictures, however, may pose a diagnostic dilemma.
CASE SUMMARY A 71-year-old female with past medial history of hypothyroidism presenting for abnormal biliary imaging. Patient’s previous evaluation was concerning for common bile duct dilation with cholelithiasis, for which she underwent a cholecystectomy. Due to persistent symptoms and worsening liver function tests, she presented to our institution for further workup. Subsequently, the patient underwent an EUS and multiple ERCP’s with cholangioscopy; biliary biopsies revealed no evidence of malignancy but concerning for prominent eosinophilic infiltration. After further review of multiple pathology specimens and the benign clinical course, we diagnosed the patient with eosinophilic cholangitis.
CONCLUSION Eosinophilic cholangitis is a rare disease and can present as a challenging case diagnostically. This case raises the potential utility of quantitative eosinophilic infiltration reporting in creating an objective diagnostic metric for eosinophilic cholangitis.
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Affiliation(s)
- Amar Dodda
- Department of Internal Medicine/Division of Gastroenterology and Hepatology, University of California–Davis, Sacramento, CA 95817, United States
| | - Karen Matsukuma
- Department of Pathology and Laboratory Medicine, University of California–Davis, Sacramento, CA 95817, United States
| | - Shiro Urayama
- Department of Internal Medicine/Division of Gastroenterology and Hepatology, University of California–Davis, Sacramento, CA 95817, United States
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Hamamoto H, Hashimoto S, Taguchi H, Kojima I, Kasai A, Tsuneyoshi K, Kuwazuru K, Arima S, Kanmura S, Ido A. Eosinophilic Gastroenteritis in Which Obstructive Jaundice Developed due to Invagination of the Duodenal Wall. Intern Med 2018; 57:1841-1847. [PMID: 29434146 PMCID: PMC6064693 DOI: 10.2169/internalmedicine.9312-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.
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Affiliation(s)
- Hitomi Hamamoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Hiroki Taguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Issei Kojima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Ai Kasai
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kengo Tsuneyoshi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kosuke Kuwazuru
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
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Adult bile duct strictures: differentiating benign biliary stenosis from cholangiocarcinoma. Med Mol Morphol 2016; 49:189-202. [PMID: 27350291 DOI: 10.1007/s00795-016-0143-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/04/2016] [Indexed: 12/17/2022]
Abstract
Biliary epithelial cells preferentially respond to various insults under chronic pathological conditions leading to reactively atypical changes, hyperplasia, or the development of biliary neoplasms (such as biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, and cholangiocarcinoma). Moreover, benign biliary strictures can be caused by a variety of disorders (such as IgG4-related sclerosing cholangitis, eosinophilic cholangitis, and follicular cholangitis) and often mimic malignancies, despite their benign nature. In addition, primary sclerosing cholangitis is a well-characterized precursor lesion of cholangiocarcinoma and many other chronic inflammatory disorders increase the risk of malignancies. Because of these factors and the changes in biliary epithelial cells, biliary strictures frequently pose a diagnostic challenge. Although the ability to differentiate neoplastic from non-neoplastic biliary strictures has markedly progressed with the advance in radiological modalities, brush cytology and bile duct biopsy examination remains effective. However, no single modality is adequate to diagnose benign biliary strictures because of the low sensitivity. Therefore, understanding the underlying causes by compiling the entire clinical, laboratory, and imaging data; considering the under-recognized causes; and collaborating between experts in various fields including cytopathologists with multiple approaches is necessary to achieve an accurate diagnosis.
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Katsinelos P, Lazaraki G, Kountouras J. Eosinophilic Enteritis Initially Presenting as Ampullary Stenosis. Clin Gastroenterol Hepatol 2016; 14:A19-20. [PMID: 26707684 DOI: 10.1016/j.cgh.2015.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Panagiotis Katsinelos
- Gastroenterology Division, Second Department of Internal Medicine, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Lazaraki
- Gastroenterology Division, Second Department of Internal Medicine, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jannis Kountouras
- Gastroenterology Division, Second Department of Internal Medicine, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Elliott JA, McCormack O, Tchrakian N, Conlon N, Ryan CE, Lim KT, Ullah N, Mahmud N, Ravi N, McKiernan S, Feighery C, Reynolds JV. Eosinophilic ascites with marked peripheral eosinophilia: a diagnostic challenge. Eur J Gastroenterol Hepatol 2014; 26:478-84. [PMID: 24535594 DOI: 10.1097/meg.0000000000000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eosinophilic disease of the gastrointestinal tract is rare and is characterized by the presence of gastrointestinal symptoms in association with eosinophilic infiltration of any part of the gastrointestinal tract. Clinical presentation of eosinophilic gastroenteritis (EGE) varies not only by the part of the gastrointestinal tract involved but also with the depth of eosinophilic infiltration of the gut wall. We describe the case of a 41-year-old woman with a history of atopy who presented with severe abdominal pain and diarrhoea. Investigations showed large-volume eosinophil-rich ascites and a markedly elevated peripheral blood eosinophil count and immunoglobulin E level. Bone marrow aspirate, trephine biopsy and T-cell studies showed no evidence of underlying haematological malignancy. Vasculitic disease and parasitic infection were systematically excluded. Colonic and upper gastrointestinal biopsies confirmed a diagnosis of EGE with eosinophilic ascites. The patient was treated with systemic corticosteroids and dietary allergen elimination with dramatic therapeutic response. The diagnostic and therapeutic challenges associated with EGE in its various forms are discussed.
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Affiliation(s)
- Jessie A Elliott
- aDepartment of Surgery, Trinity Centre, St James's Hospital and Trinity College bDepartment of Pathology cDepartment of Immunology dDepartment of Gastroenterology, St James's Hospital, Dublin, Ireland
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Seow-En I, Chiow AKH, Tan SS, Poh WT. Eosinophilic cholangiopathy: the diagnostic dilemma of a recurrent biliary stricture. Should surgery be offered for all? BMJ Case Rep 2014; 2014:bcr-2013-202225. [PMID: 24390967 DOI: 10.1136/bcr-2013-202225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old man presented with the initial diagnosis of autoimmune pancreatitis with obstructive jaundice. CT of the abdomen revealed an oedematous pancreas and dilated common bile duct (CBD), without gallstones. After failure of initial retrograde cholangiopancreatography, a percutaneous biliary catheter was inserted with good drainage. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2 cm distal CBD stricture. A biliary stent was inserted past the stricture. Biopsy of the stricture, brush cytology of the bile duct and fine needle aspiration of pancreatic head under endoscopic ultrasound guidance were negative for malignancy. Autoimmune screen was negative as well. However, the patient represented with cholangitis requiring repeat ERCP and insertion of a second biliary stent. He finally underwent cholecystectomy with excision of the distal CBD and Roux-En-Y hepaticojejunostomy. Histology revealed diffuse eosinophilic cholecystitis and cholangitis. A retrospective review of the blood results showed persistent eosinophilia in full blood count measurements from presentation and persisting throughout the treatment period.
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Affiliation(s)
- Isaac Seow-En
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
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