Hemobilia caused by cytomegalovirus cholangiopathy.
A 57-yr-old male on long-term steroid therapy presented with hematemesis, fever, and a retroperitoneal fluid collection. Hemobilia was diagnosed, but the cause was not identified by ERCP, computed tomography, or angiography. Peroral cholangioscopy revealed multiple biliary ulcers. Cholangioscopic biopsies diagnosed cytomegalovirus (CMV) infection. Intravenous ganciclovir therapy was initiated, and was associated with cessation of bleeding. Biliary CMV disease is rare in HIV-negative persons, but should be considered in a patient with unexplained hemobilia. Cholangioscopy may be useful for diagnosis.
Prasad
Ganapathy A
GA
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55901, USA.
Abraham
Susan C
SC
Baron
Todd H
TH
Topazian
Mark D
MD
D000998:Antiviral Agents / Q000627:therapeutic use; D001649:Bile Duct Diseases / Q000821:virology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000821:virology*; D003586:Cytomegalovirus Infections / Q000821:virology*; D016145:Endoscopy, Digestive System / Q000379:methods; D015774:Ganciclovir / Q000627:therapeutic use; D006431:Hemobilia / Q000209:etiology*; D006500:Hepatic Duct, Common / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014456:Ulcer / Q000821:virology
D000998:Antiviral Agents; D015774:Ganciclovir