The Great Imposture: Eosinophilic Cholangitis

A variety of benign etiologies of biliary stricture may initially be mistaken for hilar cholangiocarcinoma. Consequently, many patients undergo surgery for a benign disease that could have been treated medically. Eosinophilic cholangitis (EC) is an uncommon, benign, self-limiting disease that should be considered when approaching a case of obstructive jaundice since it causes biliary stricture forma-tion. Transmural eosinophilic infiltration of the biliary tree is characteristic of EC. It may initially be indistinguishable from hilar cholangiocarcinoma. We worked on a case of a patient who was referred to our hospital for jaundice and abdominal mass investigation with the provisional diagnosis of cholangiocarcinoma. During the workup, the index of suspicion for malignancy remained high as the typical laboratory and radiological findings for benign causes of biliary stricture were not present. Hence, the patient underwent left hepatectomy with caudate lobe resec-tion and received a retrograde diagnosis of EC. The case demonstrates that EC could present in the elderly with cardinal signs of cancer and absence of the typical findings of EC which was not previously reported. Furthermore, this disorder has been reported to respond well to steroid therapy, hence, diagnostic criteria for EC would provide another treatment option for elderly and/or those who are not fit for surgery. A 39-year-old Caucasian female with a body mass index (BMI) of 36 and a history of hamishoto’s thyroiditis, presented to the ED with worsening itching and jaundice. Patient’s thyroid function tests were within normal range. Cholesterol was 310 mg/ dL, ALP 318, ALT 24, AST 21, and GGT 1120 U/L. Liver US showed no signs of bile duct dilation. Anti-mitochondrial antibody (AMA) titers were elevated. Patient was diagnosed with primary biliary cholangitis (PBC) and was started on ursodiol. Now have To us