Academic Journal
Eosinophilic Cholangitis with Poor Prognosis after Corticosteroid- and Ursodeoxycholic Acid-Related Remission of Peripheral and Peribiliary Eosinophilia
| العنوان: | Eosinophilic Cholangitis with Poor Prognosis after Corticosteroid- and Ursodeoxycholic Acid-Related Remission of Peripheral and Peribiliary Eosinophilia |
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| المؤلفون: | Takahito Shimomura, Tomoki Nakajima, Toshiaki Nakashima, Yasutaka Morimoto, Junko Yamaoka, Akiko Shibuya, Tomoyuki Ohno, Norimasa Yoshida, Mitsuo Kishimoto, Eiichi Konishi, Hideo Tanaka, Michihisa Moriguchi, Yoshito Itoh |
| المصدر: | Case Reports in Gastroenterology, Vol 15, Iss 1, Pp 232-243 (2021) |
| بيانات النشر: | Karger Publishers, 2021. |
| سنة النشر: | 2021 |
| المجموعة: | LCC:Diseases of the digestive system. Gastroenterology |
| مصطلحات موضوعية: | eosinophilic cholangitis, sclerosing cholangitis, eosinophilic cholecystitis, Diseases of the digestive system. Gastroenterology, RC799-869 |
| الوصف: | A 79-year-old man presented with high fever, marked eosinophilia, altered biochemical liver function tests (LFT) with predominance of biliary enzymes, and severe wall thickening of the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) suggested cholecystitis, without signs of biliary strictures. Laparoscopic cholecystectomy and exploratory liver excision revealed eosinophilic cholangitis and cholecystitis, complicated with hepatitis and portal phlebitis. Prednisolone monotherapy rapidly improved peripheral eosinophilia, but not LFT. Liver biopsy showed that infiltrating eosinophils were replaced by lymphocytes and plasma cells. Treatment with ursodeoxycholic acid improved LFT abnormalities. Nevertheless, after 2 months, transaminase-dominant LFT abnormalities appeared. Transient prednisolone dose increase improved LFT, but biliary enzymes’ levels re-elevated and jaundice progressed. The second and third MRCP within a 7-month interval showed rapid progression of biliary stricture. The repeated liver biopsy showed lymphocytic, not eosinophilic, peribiliary infiltration and hepatocellular reaction to cholestasis. Eighteen months after the first visit, the patient died of hepatic failure. Autopsy specimen of the liver showed lymphocyte-dominant peribiliary infiltration and bridging fibrosis due to cholestasis. Though eosinophil-induced biliary damage was an initial trigger, repeated biopsy suggested that lymphocytes played a key role in progression of the disease. Further studies are needed to elucidate the relationship between eosinophils and lymphocytes in eosinophilic cholangitis. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 1662-0631 |
| Relation: | https://www.karger.com/Article/FullText/512420; https://doaj.org/toc/1662-0631 |
| DOI: | 10.1159/000512420 |
| URL الوصول: | https://doaj.org/article/736a4d74996c4b509463601eeb9e9b87 |
| رقم الانضمام: | edsdoj.736a4d74996c4b509463601eeb9e9b87 |
| قاعدة البيانات: | Directory of Open Access Journals |
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