A case of juvenile eosinophilic cholangitis: Rapid peripheral blood hypereosinophilia after admission leading to diagnosis

Case report: Rare benign obstructive disease of the biliary tract-a rare case of eosinophilic cholangitis

Objective

Eosinophilic cholangitis (EC) is an uncommon form of benign biliary obstruction. It frequently eludes accurate clinical diagnosis, leading to inappropriate treatment methods. It is our aspiration that this clinical report will impart comprehensive insights into EC and, specifically, the critical role of tomographic examination.

Case summary

A 34-year-old man was urgently admitted to the hospital due to excruciating abdominal distress persisting for several hours. Following a six-day course of anti-inflammatory therapy, his symptoms displayed marginal improvement, prompting his discharge. He returned to the hospital a month later for re-examination on doctor's orders. Based on the results of the re-examination, the patient refused steroid hormone shock therapy and subsequently underwent laparoscopic left-lateral hepatic lobectomy in order to confirm the diagnosis. The preoperative absolute counts of eosinophils in the peripheral blood were documented as 2.3 × 109/L, 3.06 × 109/L, and 1.50 × 109/L consecutively; concurrently, the corresponding percentages of eosinophils were quantified at levels of 21.90%, 30.70%, and 19.20%. The subsequent postoperative pathological assessment unveiled EC as the definitive diagnosis. The patient has since remained free from disease recurrence and is presently alive.

Conclusion

When encountering a patient presenting with persistent elevation in absolute eosinophil count in peripheral blood, coupled with imaging manifestations suggestive of intrahepatic periductal inflammation, diagnosis of EC should be highly suspected. The most optimal diagnostic and therapeutic workflow for EC could entail CT-guided liver lesion biopsy, ensued by glucocorticoid pulse therapy, and finally, short-term monitoring utilizing CT or MRI (including T1WI, T2WI, DWI, CEMRI) techniques.

Sustained Eosinophilic Cholangitis Due to a Mite Allergy Mimicking Sclerosing Cholangitis

Eosinophilic cholangiopathy (EC) presents with thickening and stenosis of the bile duct wall that is histologically characterized by eosinophil infiltration. The diagnosis is often difficult. We herein report a patient who had been followed up with a diagnosis of primary sclerosing cholangitis but had a final diagnosis of EC based on eosinophilia, histological findings of bile duct and liver biopsy specimens, and a review of a previous surgical specimen of the gallbladder. Antigen tests, isolation from her house, and accidental re-exposure to the antigen revealed that the causative antigen was the mite Dermatophagoides pteronyssinus.

A case of eosinophilic cholangitis without bile duct stenosis diagnosed by bile duct biopsy

Eosinophilic cholangitis (EC) is a rare benign disease that is often misdiagnosed as a malignancy due to the development of biliary stricture. This disease is generally diagnosed by liver biopsy or surgery. Herein, we report a case of EC diagnosed in an 86-year-old Japanese woman, who presented with fever, elevated eosinophil count, and elevated liver enzyme level, based on intraductal ultrasound evaluation showing bile duct wall thickening and bile duct biopsy of the same site. We diagnosed this case as EC based on the triad of wall thickening of the biliary system, histopathological findings of eosinophilic infiltration of the biliary tract, and reversibility of biliary abnormalities without treatment. Bile duct biopsy during endoscopic retrograde cholangiopancreatography (ERCP) is rarely used to confirm the diagnosis of EC without bile duct stenosis. For EC and cholecystitis associated with eosinophilia, bile duct biopsy under ERCP, which is less invasive, should be considered. This patient was older than the previously reported patients, and the value of a minimally invasive diagnosis was high.