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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
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Corona again? SSC after a severe COVID-disease
Benno Arnstadt1, Christian Zillinger2, Marcus Treitl3
1Klinikum Garmisch-Partenkirchen GmbH, Garmisch-Partenkirchen, Germany.
Zeitschrift Fur Gastroenterologie
|October 19, 2021
Summary
Secondary sclerosing cholangitis (SSC) is a severe complication in critically ill patients, often missed. Early diagnosis using endoscopic ultrasound (EUS) is crucial for managing this condition, especially in COVID-19 survivors.
Area of Science:
- Hepatology
- Gastroenterology
- Critical Care Medicine
Background:
- Secondary sclerosing cholangitis (SSC) is a severe complication of critical illness.
- SSC-CIP is characterized by rapid cholestasis and can progress to cirrhosis and liver failure.
- COVID-19 survivors requiring intensive care are at risk for developing SSC.
Observation:
- A 62-year-old patient with severe COVID-19 pneumonia developed critical-illness-polyneuropathy and cholestasis.
- Cholestasis persisted and progressed after COVID-19 recovery, despite neurological improvement.
- Magnetic resonance cholangiopancreatography (MRCP) showed irregular intrahepatic bile ducts.
Findings:
- Endoscopic ultrasound (EUS) revealed intraductal casts, characteristic of SSC-CIP.
- Endoscopic retrograde cholangiography (ERC) confirmed necrotic bile ducts, which were extracted for analysis.
- Histological and molecular analysis provided confirmation of SSC-CIP.
Implications:
- SSC is an underdiagnosed condition that can affect COVID-19 patients.
- EUS is a key diagnostic tool for identifying intraductal casts in cholestasis.
- Early diagnosis and management, potentially including ERC programs, are vital to prevent disease progression and cirrhosis.
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