Sclerosing cholangitis and liver cirrhosis after extrabiliary infections: report on three cases.
OBJECTIVE
To describe three unusual cases of sclerosing cholangitis after severe extrahepatic/extrabiliary bacterial infections.


METHODS
Case report, clinical.


METHODS
Tertiary care intensive care unit (ICU).


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


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.


CONCLUSIONS
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.
Department of Medicine, the University of Wuerzburg, Wuerzburg, Germany. w.scheppach@medizin.uni-wuerzburg.de
W
W
Scheppach
G
G
Druge
G
G
Wittenberg
J G
JG
Mueller
A M
AM
Gassel
H J
HJ
Gassel
F
F
Richter
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000145:classification / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D002779:Cholestasis / Q000145:classification / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D003422:Critical Care; D018450:Disease Progression; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D002756:Cholagogues and Choleretics