title: Eosinophilic Cholangitis--A Challenging Diagnosis of Benign Biliary Stricture: A Case Report.
abstract: When confronting a biliary stricture, both benign and malignant etiologies must be carefully considered as a variety of benign biliary strictures can masquerade as hilar cholangiocarcinoma (CCA). Therefore, patients could undergo a major surgery despite the possibility of a benign biliary disease. Approximately 15% to 24% of patients undergoing surgical resection for suspected biliary malignancy will have benign pathology. Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract, which can cause obstructive jaundice and can pose a difficult diagnostic task. We present a rare case of a young woman who was referred to our hospital with obstructive painless jaundice due to a biliary stricture at the confluence of the hepatic bile ducts, with a provisional diagnosis of cholangiocarcinoma. Though, during her work up she was found to have EC, an extremely rare benign cause of biliary stricture, which is characterized by a dense eosinophilic infiltration of the biliary tree causing stricturing, fibrosis, and obstruction and which is reversible with short-term high-dose steroids. Despite its rarity, EC should be taken into consideration when imaging modalities demonstrate a biliary stricture, especially if preoperative diagnosis of malignancy cannot be made, in the setting of peripheral eosinophilia and the absence of cardinal symptoms of malignancy.
authors.affiliation: From the 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School (GPF, AIV, EAK, EVP, AAP); Department of Gastroenterology, Division of Endoscopy, Athens Naval Hospital (GGS); Department of Pathology, Aretaieio Hospital, University of Athens, Medical School (ANP); 1st Department of Radiology, Aretaieio Hospital, University of Athens, Medical School (VKK); and Department of Hepatology, Evangelismos General Hospital, Athens, Greece (MKM).
authors.forename: Georgios Panagiotis
authors.initials: GP
authors.lastname: Fragulidis
authors.forename: Antonios I
authors.initials: AI
authors.lastname: Vezakis
authors.forename: Elissaios A
authors.initials: EA
authors.lastname: Kontis
authors.forename: Eirini V
authors.initials: EV
authors.lastname: Pantiora
authors.forename: Gerasimos G
authors.initials: GG
authors.lastname: Stefanidis
authors.forename: Aikaterini N
authors.initials: AN
authors.lastname: Politi
authors.forename: Vasilios K
authors.initials: VK
authors.lastname: Koutoulidis
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mela
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Polydorou
mesh_terms: D000328:Adult; D001652:Bile Ducts; D002761:Cholangitis / Q000139:chemically induced* / Q000175:diagnosis*; D003251:Constriction, Pathologic / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans