Granulomatous hepatitis and cholangitis associated with giardiasis

Area of Science:

• Hepatology
• Infectious Diseases
• Gastroenterology

Background:

• Giardiasis is a common intestinal infection caused by Giardia lamblia.
• Liver involvement in giardiasis is rare but can manifest as granulomatous hepatitis or cholangitis.
• Chronic diarrhea, weight loss, fever, hypoalbuminemia, and anemia are common symptoms of severe giardiasis.

Observation:

• A woman presented with chronic diarrhea, weight loss, fever, hypoalbuminemia, and anemia.
• Liver biopsy revealed granulomas in portal tracts and cholangitis, initially attributed to giardiasis.
• The patient had normal IgG and IgM, elevated IgA, detectable anti-Giardia antibodies, and an HLA phenotype (B12, B27) associated with prolonged giardiasis.

Findings:

• Eradication of Giardia infection resulted in rapid improvement of the patient's symptoms.
• A follow-up liver biopsy after 3 months showed resolution of the initial histologic changes.
• This case highlights the potential for Giardia to cause significant liver pathology.

Implications:

• Prompt diagnosis and treatment of giardiasis are crucial, even in the presence of liver involvement.
• Liver biopsy findings can be reversible upon successful treatment of the underlying parasitic infection.
• Further research may elucidate the mechanisms linking specific HLA types to prolonged giardiasis and associated liver disease.