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Sclerosing cholangitis and liver cirrhosis after extrabiliary infections: report on three cases
W Scheppach1, G Druge, G Wittenberg
1Department of Medicine, the University of Wuerzburg, Wuerzburg, Germany. w.scheppach@medizin.uni-wuerzburg.de
Objective:
To describe three unusual cases of sclerosing cholangitis after severe extrahepatic/extrabiliary bacterial infections.
Design:
Case report, clinical.
Setting:
Tertiary care intensive care unit (ICU).
Patients:
Three patients admitted to the ICU with infections from Gram-positive bacteria followed by sclerosing cholangitis and secondary biliary cirrhosis.
Main Results:
Three unusual cases of persisting cholestasis that occurred after bacterial infections originating from extrahepatic/extrabiliary foci are described. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed multiple strictures of the intrahepatic bile ducts as a sign of sclerosing cholangitis. All patients progressed to biliary cirrhosis within months after the onset of cholestasis.
Conclusion:
Infection-associated cholestasis is usually a functional disorder and subsides after effective treatment of the underlying inflammatory focus. In rare cases, however, extrahepatic/extrabiliary infections may lead to sclerosing cholangitis and secondary biliary cirrhosis via unknown mechanisms.