AIDS-related cholangitis: radiographic findings in nine patients

Acalculous inflammation of the biliary tract is a recently reported complication of the acquired immunodeficiency syndrome (AIDS). In a 33-month period, nine men with AIDS were evaluated because of right upper quadrant and/or epigastric pain, jaundice, or abnormal liver function test results. Each patient underwent ultrasonography and endoscopic retrograde cholangiopancreatography; seven also underwent computed tomography. In eight of nine patients the imaging studies disclosed intrahepatic and extrahepatic bile duct changes identical to those seen in sclerosing cholangitis (strictures, focal dilatation, thickened duct walls). Isolated papillary stenosis and ductal dilatation were present in one patient, while eight patients had some stricturing of the distal common duct. The combination of papillary stenosis and intrahepatic ductal strictures appears unique to AIDS-related cholangitis. Endoscopic papillotomy provided variable relief to symptoms and biochemical abnormalities. Cholangitis caused by cytomegalovirus and/or Cryptosporidium infection is the proposed pathophysiologic mechanism.