Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 21, 2009; 15(11): 1394-1397
Published online Mar 21, 2009. doi: 10.3748/wjg.15.1394
Resected case of eosinophilic cholangiopathy presenting with secondary sclerosing cholangitis
Fumihiko Miura, Takehide Asano, Hodaka Amano, Masahiro Yoshida, Naoyuki Toyota, Keita Wada, Kenichiro Kato, Tadahiro Takada, Junichi Fukushima, Fukuo Kondo, Hajime Takikawa
Fumihiko Miura, Takehide Asano, Hodaka Amano, Masahiro Yoshida, Naoyuki Toyota, Keita Wada, Kenichiro Kato, Tadahiro Takada, Department of Surgery, Teikyo University, School of Medicine, Tokyo, 173-8605, Japan
Junichi Fukushima, Fukuo Kondo, Department of Pathology, Teikyo University, School of Medicine, Tokyo, 173-8605, Japan
Hajime Takikawa, Department of Medicine, Teikyo University, School of Medicine, Tokyo, 173-8605, Japan
Author contributions: Miura F and Kondo F contributed equally to this work; Miura F, Asano T, Kondo F and Fukushima J designed the research; Miura F, Amano H, Toyota N, Wada K and Kato K performed the research; Takada T and Takikawa H analysed the data; and Miura F, Kondo F, and Yoshida M wrote the paper.
Correspondence to: Takehide Asano, MD, Department of Surgery, Teikyo University, School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. asn@med.teikyo-u.ac.jp
Telephone: +81-3-39641228
Fax: +81-3-39622128
Received: December 26, 2008
Revised: February 19, 2009
Accepted: February 26, 2009
Published online: March 21, 2009
Abstract

Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinophilic cholecystitis. A 46-year-old Japanese man was admitted to our hospital with jaundice. Computed tomography revealed dilatation of both the intrahepatic and extrahepatic bile ducts, diffuse thickening of the wall of the extrahepatic bile duct, and thickening of the gallbladder wall. Under the diagnosis of lower bile duct carcinoma, he underwent pylorus-preserving pancreatoduodenectomy and liver biopsy. On histopathological examination, conspicuous fibrosis was seen in the lower bile duct wall. In the gallbladder wall, marked eosinophilic infiltration was seen. Liver biopsy revealed mild portal fibrosis. He was diagnosed as definite eosinophilic cholecystitis with sclerosing cholangitis with unknown etiology. The possible etiology of sclerosing cholangitis was consequent fibrosis from previous eosinophilic infiltration in the bile duct. The clinicopathological findings of our case and a literature review indicated that eosinophilic cholangiopathy could cause a condition mimicking primary sclerosing cholangitis (PSC). Bile duct wall thickening in patients with eosinophilic cholangitis might be due to fibrosis of the bile duct wall. Eosinophilic cholangiopathy might be confused as PSC with eosinophilia.

Keywords: Eosinophilc cholangiopathy; Primary sclerosing cholangitis; Secondary sclerosing cholangitis; Obstructive jaundice