Severe eosinophilic cholangitis with parenchymal destruction of the left hepatic lobe due to hydatid disease

Abstract

Hydatid cysts of the liver are known to occasionally rupture into the bile ducts and cause cholangitis. The histological features of this complication have not been adequately described in the literature. Herein is reported a case of severe eosinophilic cholangitis of the left hepatic lobe, occurring in a 24-year-old man with a large (16 cm) hydatid cyst, which obstructed and eroded the left hepatic duct. The patient presented with upper abdominal discomfort and low-grade fever of 3 weeks' duration. Sections of the left lobectomy specimen showed marked inflammatory infiltrates in the portal tracts, predominantly composed of eosinophils, extensively involving bile ducts of all sizes. Occasional small bile ducts were replaced by epithelioid cell granulomas surrounding eosinophilic microabscesses. The inflammatory infiltrates extended into the lobules, resulting in marked hepatocyte loss. This case demonstrates that echinococcosis may cause severe eosinophilic cholangitis with extensive parenchymal destruction, apparently resulting from a hypersensitivity reaction to parasitic antigens.

A Case of Hypereosinophilia-Associated Multiple Mass Lesions of Liver Showing Non-Granulomatous Eosinophilic Hepatic Necrosis

“…In our case, parasite infection, particularly visceral larva migrans, had to be differentiated because hepatic involvement with eosinophilia and multiple lesion on imaging is frequently observed. To our knowledge, the characteristic histological finding of parasitic infection is eosinophilic granuloma in almost cases, except one case of hydatid disease showing eosinophilic cholangitis [1, 2, 12-13]. It seemed that the possibility of visceral larva migrans could be denied because the granulomatous reaction was not found at all in liver biopsy, and antihelminthic treatment was not needed in our patient.…”

Eosinophilia in Infectious Diseases

“…However, immediately following a clinically significant cyst rupture (often iatrogenic), eosinophil counts are transiently suppressed (<500) while neutrophils significantly increase [106-108]. Eosinophils then progressively rise to moderately high levels over the next several days to weeks [108-110]. Abdominal pain with an elevated bilirubin is seen if the cyst ruptures into the biliary tree.…”

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

“…The exact cause for this disease remains unknown, but there has been previously reported association with cholelithiasis,2 idiopathic hypereosinophilic syndrome,3 parasitic infection4 5 and allergy 6. Symptomatic eosinophilic infiltration of organs other than the biliary tree has also been reported to occur in association, either presenting simultaneously or up to 14 years after treatment of eosinophilic cholangiopathy.…”

“…Nevertheless, these patients had uneventful postoperative periods and did not have recurrence of disease for a follow-up period ranging from 2 months to 40 months. Raptou et al 5 described a case of eosinophilic cholangitis secondary to hydatid disease surgically treated by lobectomy with Roux-en-Y hepaticojejunostomy and is not included in this table.…”