Sclerosing cholangitis and liver cirrhosis after extrabiliary infections: report on three cases

Abstract

Objective: To describe three unusual cases of sclerosing cholangitis after severe extrahepatic/extrabiliary bacterial infections.

Design: Case report, clinical.

Setting: Tertiary care intensive care unit (ICU).

Patients: Three patients admitted to the ICU with infections from Gram-positive bacteria followed by sclerosing cholangitis and secondary biliary cirrhosis.

Main results: Three unusual cases of persisting cholestasis that occurred after bacterial infections originating from extrahepatic/extrabiliary foci are described. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed multiple strictures of the intrahepatic bile ducts as a sign of sclerosing cholangitis. All patients progressed to biliary cirrhosis within months after the onset of cholestasis.

Conclusion: Infection-associated cholestasis is usually a functional disorder and subsides after effective treatment of the underlying inflammatory focus. In rare cases, however, extrahepatic/extrabiliary infections may lead to sclerosing cholangitis and secondary biliary cirrhosis via unknown mechanisms.