A case of eosinophilic cholangitis: Imaging findings of contrast-enhanced ultrasonography, cholangioscopy, and intraductal ultrasonography

Abstract

A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils. Treatment was started with prednisolone 60 mg daily. The patient's biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile duct. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient's eosinophil count was over 1000/mm 3 . Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.

Marked Eosinophilia as the First Manifestation of Sclerosing Cholangitis

“…Eosinophilic cholangiopathy is one of the causes of sclerosing cholangitis (12)(13)(14)(15)(16). However, the literature contains only about 40 case reports on eosinophilic cholangiopathy (15)(16)(17), and therefore, little at- (18) E n d o s c o p i c r e t r o g r a d e c h o l a n g i o p a n c r e a t o g r a p h y ( E RCP ) f i n d i n g s . E RCP r e v e a l e d s c l e r o s i n g , n a r r o wi n g a n d d i f f u s e o b s t r u c t i o n c o mp a t i b l e wi t h s c l e r o s i n g c h o l a n g i t i s .…”

“…However, the pathoetiological significance of eosinophils in PSC remains to be elucidated. Eosinophilic cholangiopathy is one of the causes of sclerosing cholangitis (12)(13)(14)(15)(16). However, the literature contains only about 40 case reports on eosinophilic cholangiopathy (15)(16)(17), and therefore, to date little attention has been paid to this condition.…”

Eosinophilic cholangiopathy: the diagnostic dilemma of a recurrent biliary stricture. Should surgery be offered for all?

“…Matsumoto et al 13 proposed the diagnostic criteria of (1) wall thickening or stenosis of the biliary system; (2) histopathological findings of eosinophilic infiltration; and (3) reversibility of biliary abnormalities without treatment or following steroid treatment. However, histological confirmation of eosinophilia prior to surgery is often not possible with EUS, bile duct biopsies and brushings usually being non-diagnostic.…”

Eosinophilic cholangitis diagnosed endoscopically

“…Eosinophilic cholangitis is part of a spectrum of diseases that all show eosinophilic infiltration of organs, with or without peripheral eosinophilia [6,7]. Suggested diagnostic criteria include thickening or obstruction of the bile ducts, infiltration with eosinophils on bile duct biopsy, and improvement with immunosuppression [6]. The present case is one of only a few cases of eosinophilic cholangitis to be diagnosed without surgery, which allowed us to consider other potential therapeutic strategies as alternatives.…”

“…It can result in the formation of strictures within the biliary tree [2 -4], as it is characterized by marked fibrosis of the bile ducts [5]. Eosinophilic cholangitis is part of a spectrum of diseases that all show eosinophilic infiltration of organs, with or without peripheral eosinophilia [6,7]. Suggested diagnostic criteria include thickening or obstruction of the bile ducts, infiltration with eosinophils on bile duct biopsy, and improvement with immunosuppression [6].…”