Eosinophilic cholangitis treatment with budesonide

doi:10.4254/wjh.v9.i36.1385

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World Journal of Hepatology

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1948-5182

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World J Hepatol. Dec 28, 2017; 9(36): 1385-1388
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1385

Eosinophilic cholangitis treatment with budesonide

Marianne Anastasia De Roza, Chee Hooi Lim

Marianne Anastasia De Roza, Chee Hooi Lim, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169856, Singapore

Author contributions: De Roza MA and Lim CH designed the report and analyzed the data; Lim CH reported and monitored outcomes; De Roza MA wrote the report; Both De Roza MA and Lim CH made critical revisions before final approval of the report.

Conflict-of-interest statement: There is no conflict of interest for all authors.

Correspondence to: Marianne Anastasia De Roza, MB.BS, MMED (Int Med), MRCP (UK), Registrar, Department of Gastroenterology and Hepatology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore. marianneanastasia.deroza@mohh.com.sg

Telephone: +65-326-6693

Received: September 21, 2017
Peer-review started: September 22, 2017
First decision: October 17, 2017
Revised: October 21, 2017
Accepted: November 11, 2017
Article in press: November 12, 2017
Published online: December 28, 2017
Processing time: 96 Days and 23.9 Hours

ARTICLE HIGHLIGHTS

Case characteristics

Deranged liver function test with a cholestatic pattern, eosinophilia, raised IgE, intrahepatic biliary stricture.

Clinical diagnosis

Eosinophilic cholangitis.

Differential diagnosis

Biliary stone, pancreaticobiliary malignancy, drug induced liver injury.

Laboratory diagnosis

Eosinophilic cholangitis.

Imaging diagnosis

Biliary stricture and dilation.

Pathological diagnosis

Eosinophilic cholangitis.

Treatment

Budesonide 9 mg once a day.

Related reports

There are no previous reports of treating eosinophilic cholangitis with Budesonide. But there are reports of successful treatment with prednisolone. Please see reference No. 2.

Experiences and lessons

This is a rare case of eosinophilic cholangitis and the first time in literature, to be successfully treated with budesonide. The patient did not experience any side effects or steroid toxicity. In the future, with further evidence, budesonide might be a reasonable first line treatment for eosinophilic cholangitis as it is safer than prednisolone.