Advanced Endoscopy Fellows Program | September 2022-Hosmer

Hosmer_Biliary Case

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This document is a case review discussing a patient presenting with symptoms of jaundice, pruritus, fatigue, and unintentional weight loss. The patient has a history of gout and hypertension and is a social drinker. Initial lab results show elevated liver enzymes and bilirubin, and the patient tests positive for COVID-19. Imaging with CT and MRI/MRCP is recommended for further diagnosis. The patient undergoes ERCP and repeat ERCP, and brushings reveal rare atypical ductal cells. Additional workup includes CA-19-9 testing, which shows elevated levels, and negative results for acute hepatitis, AMA, and SMA. However, ANA is positive and IgG4 levels are elevated. These findings suggest a diagnosis of IgG4 related cholangiopathy, a systemic inflammatory disorder associated with elevated levels of IgG4 or bile duct inflammation. Clinical features of this condition include stricturing of the common bile duct, jaundice, and biliary tract changes similar to primary sclerosing cholangitis. Treatment options include corticosteroids and immunomodulatory agents. Follow-up is necessary to monitor response to treatment and predict relapse.

Keywords

jaundice

pruritus

fatigue

unintentional weight loss

gout

hypertension

COVID-19

elevated liver enzymes

bilirubin

IgG4 related cholangiopathy