Cholangitis in viral disease

This review of biliary manifestations of viral diseases includes aspects of morphologic diagnosis, therapeutic implications, prognostic effect, and natural history. The viral causes of cholangitis are reviewed, with subclassification on the basis of primary hepatic versus systemic infections and immune competence of the host. Special attention is given to the histopathologic and clinical features of viruses affecting the biliary tree. Among hepatotropic viruses, hepatitis C more frequently is associated with cholangitis than is hepatitis B. In both hepatitis B and hepatitis C, the lymphocytic cholangitis duct damage is reversible and does not adversely influence the course of disease or response to therapy. Hepatitis A and hepatitis E, despite causing clinical cholestasis, do not result in severe cholangitis. The effect of systemic viruses on the biliary tree is primarily dependent on the status of the host immune system. Infants and severely immunosuppressed patients (such as those who have undergone liver transplantation) are at risk for cytomegalovirus cholangitis, whereas patients with late-stage acquired immunodeficiency syndrome (AIDS) are at risk for cholangitis due to numerous organisms. Overall, cholangitis attributable to viral disease encompasses a wide spectrum of clinicopathologic scenarios, depending on the etiologic virus and the immune competence of the host.