Reversible sclerosing cholangitis with ulcerative colitis.

Area of Science:

• Hepatology
• Gastroenterology
• Immunology

Background:

• Sclerosing cholangitis (SC) is a chronic liver disease characterized by bile duct inflammation and fibrosis.
• Granulocytic epithelial lesions (GEL) are a specific histological finding within the bile ducts, often associated with SC.
• Ulcerative colitis (UC) is an inflammatory bowel disease that can sometimes be associated with liver manifestations like SC.

Observation:

• A 42-year-old female with active ulcerative colitis presented with elevated alkaline phosphatase and dilated intrahepatic bile ducts.
• Liver biopsy confirmed granulocytic epithelial lesions (GEL) with neutrophil infiltration into the bile duct epithelium.
• Treatment with prednisolone (PSL) was initiated due to active ulcerative colitis.

Findings:

• Prednisolone therapy led to a dramatic decrease in abnormal laboratory values.
• Follow-up liver biopsy showed resolution of neutrophil infiltration in the bile duct epithelium.
• Immunohistochemical analysis revealed no IgG4-positive plasma cells, differentiating it from IgG4-related sclerosing cholangitis.

Implications:

• This case demonstrates the efficacy of immunosuppression, specifically prednisolone, in treating SC with GEL.
• It provides valuable insights into treatment-induced histological changes and serial biochemical data during immunosuppressive therapy for this rare condition.
• The findings suggest that GEL-positive SC may be a distinct entity responsive to targeted immunosuppression.