title: Rare case of severe cholangiopathy following critical illness.
abstract: Secondary sclerosing cholangitis is a rare condition caused by disorders directly damaging the biliary tree. We present a case of a 34-year-old man with no pre-existing hepatobiliary disease who developed significant cholestasis and subsequent cholangitis while in the intensive care unit for multiorgan failure secondary to H1N1 influenza A (swine flu). After discharge from the intensive care unit, jaundice, fevers, abdominal pain, pruritus and ongoing cholestasis persisted, consistent with recurrent cholangitis. Secondary sclerosing cholangitis was confirmed by liver biopsy and endoscopic retrograde cholangiopancreatography. This is a case of the recently described syndrome of secondary sclerosing cholangitis following critical illness, with associated severe hypoxic and ischaemic injury. He subsequently developed recognised complications of sclerosing cholangitis, including fat-soluble vitamin deficiencies, recurrent cholangitis and liver fibrosis. To the best of our knowledge, this is the first reported case of secondary sclerosing cholangitis following critical illness in the UK.
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Kamal Vijaykant
authors.initials: KV
authors.lastname: Patel
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Sameer
authors.initials: S
authors.lastname: Zaman
authors.affiliation: Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Fuju
authors.initials: F
authors.lastname: Chang
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000209:etiology*; D002779:Cholestasis / Q000209:etiology*; D016638:Critical Illness; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications*; D008297:Male