MBHs are rare benign liver lesions, also known as von Meyenburg complexes, and were first described in the early 20th century. They consist of multiple small interlobular biliary cystic lesions or hamartomas that are not connected to the main biliary tree. MBHs are the result of biliary ductal plate malformations during embryonic development. MBHs are usually asymptomatic and are found incidentally. It is key to differentiate MBHs from metastases, simple liver cysts, and Caroli's disease.MBHs are easily detectable on cross-sectional imaging, and a liver biopsy is usually not necessary. MRCP with contrast material reveals multiple small (<15-mm) irregular cystic liver lesions without attenuation or enhancement, and the extrahepatic and intrahepatic biliary trees are normal. By contrast, liver metastatic lesions and Caroli's disease show contrast enhancement. As seen in the case described here, MBHs can become infected, which can lead to cholangitis and lifethreatening septic shock, as seen in this case.Fewer than 15 MBH cases of cholangitis have been reported in the literature. The most common reported microorganisms are Escherichia coli, Enterococcus faecium, Enterobacter cloacae, and Klebsiella pneumoniae. Over 90% of reported cases of MBHs with cholangitis had a single cholangitis episode and responded to intravenous antibiotics. Notably, Panda et al reported a case of MBH that required liver transplantation for the treatment of recurrent cholangitis. Finally, MBHs are rare biliary duct congenital abnormalities that can be complicated by cholangitis, but they usually respond to antibiotics, and endoscopic or surgical interventions are generally not necessary in most instances.
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