Eosinophilic cholangitis: A case report of diagnostically challenging eosinophilic infiltrative biliary obstruction

BACKGROUND Evaluation of biliary strictures primarily focuses on ruling out malignancy in older age groups.With endoscopic tools such as endoscopic ultrasound(EUS)and cholangioscopy,improved biliary visualization has enhanced the investigation of intraluminal biliary lesions and provided modalities for targeted biopsies.Benign biliary strictures,however,may pose a diagnostic dilemma.CASE SUMMARY A 71-year-old female with past medial history of hypothyroidism presenting for abnormal biliary imaging.Patient’s previous evaluation was concerning for common bile duct dilation with cholelithiasis,for which she underwent a cholecystectomy.Due to persistent symptoms and worsening liver function tests,she presented to our institution for further workup.Subsequently,the patient underwent an EUS and multiple ERCP’s with cholangioscopy;biliary biopsies revealed no evidence of malignancy but concerning for prominent eosinophilic infiltration.After further review of multiple pathology specimens and the benign clinical course,we diagnosed the patient with eosinophilic cholangitis.CONCLUSION Eosinophilic cholangitis is a rare disease and can present as a challenging case diagnostically.This case raises the potential utility of quantitative eosinophilic infiltration reporting in creating an objective diagnostic metric for eosinophilic cholangitis.

Effect of Treatment for CHC on Liver Disease Progression and Hepatocellular Carcinoma Development in African Americans

Background and Aims:African Americans (AA) historically have a low response rate to hepatitis C therapies,and there is limited information available for this patient population regarding the development and treatment of chronic hepatitis C (CHC).The aim of this study was to evaluate liver disease progression and hepatocellular carcinoma (HCC) development in AA with CHC.Methods:Between 1995 and 2008,246 AA patients with CHC were identified from a database of patients and followed until 2012-2013 (average 8 years)or the development of HCC after 2008.Results:Viral clearance (intent to treat;sustained virus response (SVR)) was achieved in 15% of patients with interferon based therapies with or without ribavirin.AA patients who achieved an SVR (n=22) did not develop HCC or new onset cirrhosis,whereas the HCC incidence in untreated AA patients was 23% (51/203).Patients who achieved an SVR also had improved fibrosis,as defined by the AST Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) score,relative to nonresponders and untreated patients.Conclusions:The severity of liver disease at the first visit (except for cirrhosis) correlated with the development of HCC,but because of the overlap in values between patients,these measurements were not useful for predicting individual risk.Since cirrhosis at the first visit was not a predictive factor,treatment with newer antiviral therapies is the best option for reducing the incidence of advanced liver disease and its harmful outcomes in the AA population.