Ukita Kentaro, Izumikawa Koichi, Ishihama Sawako, Nishiyama Masashi, Sakakihara Ichiro, Wato Masaki, Takaguchi Koichi
Postgraduate Clinical Training Center Kagawa Prefectural Central Hospital Kagawa Japan.
Department of General Medicine Kagawa Prefectural Central Hospital Kagawa Japan.
DEN Open. 2022 Apr 5;2(1):e108. doi: 10.1002/deo2.108. eCollection 2022 Apr.
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.
嗜酸性胆管炎（EC）是一种罕见的良性疾病，由于胆管狭窄的出现，常被误诊为恶性肿瘤。这种疾病通常通过肝活检或手术来诊断。在此，我们报告一例在一名86岁日本女性中诊断出的EC病例，该患者表现为发热、嗜酸性粒细胞计数升高和肝酶水平升高，基于导管内超声评估显示胆管壁增厚以及同一部位的胆管活检结果。我们根据胆道系统壁增厚、胆道嗜酸性粒细胞浸润的组织病理学发现以及未经治疗的胆道异常的可逆性这三联征，将该病例诊断为EC。在内镜逆行胰胆管造影（ERCP）期间进行胆管活检很少用于在无胆管狭窄的情况下确诊EC。对于与嗜酸性粒细胞增多相关的EC和胆囊炎，应考虑在ERCP下进行侵入性较小的胆管活检。该患者比先前报道的患者年龄更大，微创诊断的价值很高。
