2021 Volume 63 Issue 1 Pages 52-60
A 78-year-old female who had taken prednisolone 5mg/day for neuromyelitis optica had fever and right hypochondriac pain. Laboratory evaluation showed elevated hepatobiliary enzyme level, C-reactive protein level, and proportion of eosinophils. Abdominal enhanced computed tomography showed thickening and enhancement of the bile duct wall. Endoscopic retrograde cholangiography (ERC) showed irregularity of the extrahepatic bile duct wall. Cholangioscopy showed edema and unevenness of the bile duct wall, but there was no malignant finding. Biopsy specimens of the bile duct and liver showed infiltration of eosinophils into the bile duct wall. Considering the above findings, we made the diagnosis of eosinophilic cholangitis and increased her prednisolone dose to 25mg/day. Repeat ERC and bile duct biopsy showed normal bile duct on cholangiogram and disappearance of eosinophilic infiltration into the bile duct wall. Cholangioscopy may contribute to differentiation of eosinophilic cholangitis from primary sclerosing cholangitis or bile duct cancer.
