Acute cholangitis (AC) in the setting of iron overload with suspected Epstein-Barr virus (EBV) infection

3^rd Global Experts Meeting on Medical Case Reports

May 09-10, 2016 New Orleans, USA

Kassem Faraj

Oakland University William Beaumont School of Medicine, USA

Posters & Accepted Abstracts: J Clin Case Rep

Abstract :

Acute cholangitis (AC) is an infection of the biliary tract caused by biliary obstruction and stasis. The most common symptoms are fever and abdominal pain, which are seen in 80% of patients. A 47 year old male presented with a three week history of scleral icterus, dark urine and pale stools, consistent with jaundice. He complained of fatigue, but denied any abdominal pain, fever, chills, nausea or vomiting. Laboratory results were significant for AST 959 IU/L, ALT 1563 IU/L, alkaline phosphatase 199 IU/L, total bilirubin 24.0 IU/L, direct bilirubin 19.9 IU/L, total iron 246 mcg per dL, ferritin 5008 ng/mL and transferrin saturation 85%. An acute hepatitis panel was negative and an abdominal ultrasound and CT scan were unremarkable. Serology results for EBV included: IgG 279, EB-EA (early antigen) >150, EB-NA (nuclear antigen) 544 and a normal IgM. Reactivation of EBV was suspected and a diagnosis of EBV hepatitis was made. The patient did not improve with supportive measures, prompting a liver biopsy, which showed acute inflammation, periportal fibrosis and neutrophillic infiltration and cholestasis of the biliary tree, which was consistent with AC. MRCP was unremarkable for biliary dilatation. The patient was managed supportively and gradually improved. This case presented major challenges to clinicians including the lack of classic symptoms and biliary dilatation on imaging, the apparent iron overload and the presence of a recent EBV infection. Biliary dilatation is very common, but is not necessary for the diagnosis of AC. Mild cases can be managed with close observation.

Biography :

Email: kfaraj@oakland.edu