title: Reversible sclerosing cholangitis with ulcerative colitis.
abstract: Sclerosing cholangitis (SC) with granulocytic epithelial lesion (GEL) responds well to immunosuppression therapy. We treated a 42-year-old Japanese female with ulcerative colitis, who was admitted for further evaluation of both an elevated alkaline phosphatase level and dilated intrahepatic bile ducts. A liver biopsy on the fourth hospital day revealed the infiltration of neutrophils into the bile duct epithelium, which was diagnosed as GEL. Because her ulcerative colitis was in an active stage, prednisolone (PSL) therapy was started. After the administration of PSL, laboratory data dramatically decreased. A liver biopsy was performed on the 66th hospital day to confirm the lesion around bile ducts in the portal tract. The infiltration of neutrophils into the bile duct epithelium disappeared after PSL administration, and IgG4-positive plasma cells were not found in the liver. Herein, we report a rare case of GEL-positive SC. The present case provides early evidence of treatment-induced histological changes as well as serial changes in biochemical data during the course of immunosuppression therapy.
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kakisaka
authors.affiliation: Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Kataoka
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yanai
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Hidekatsu
authors.initials: H
authors.lastname: Kuroda
authors.affiliation: Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sugai
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takikawa
keywords: GEL; PR3-ANCA; granulocytic epithelial lesion; sclerosing cholangitis