Subject(s)
Lymphangioma, Cystic/diagnostic imaging , Omentum/diagnostic imaging , Peritoneal Neoplasms/diagnostic imaging , Humans , Lymphangioma, Cystic/pathology , Lymphangioma, Cystic/surgery , Male , Middle Aged , Omentum/pathology , Omentum/surgery , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/surgery , Tomography, X-Ray Computed , UltrasonographyABSTRACT
About 60 cases of cholangitis in patients with the acquired immune deficiency syndrome (AIDS) have been described. We report our experience concerning 15 patients infected with the human immunodeficiency virus (HIV) and who had cholangitis as defined by radiological findings. Cholangitis was the revealing event of AIDS or HIV infection in 4 patients (27%). Twelve (80%) of the patients were homosexual men. The main diagnostic features were abdominal pain (73%), cholestasis without jaundice (100%), intestinal cryptosporidiosis (80%) and abnormal findings on abdominal ultrasonography (87%). Endoscopic retrograde cholangiopancreatography appears to be essential for diagnostic and therapeutic purposes, particularly for patients with papillary stenosis who represented 64% of our population. Biological and morphological pancreatic abnormalities were associated in 2 of the 8 patients who underwent retrograde opacification of the Wirsung duct. The microbiological yield was highest in patients who underwent multiple biopsies (duodenal and papillary) and bile sampling. The organisms found included Cryptosporidium (57%) of cases), CMV (28%) and Microsporidia (7%). Twelve-month survival after the diagnosis of cholangitis was only 14% and all deaths were related to AIDS progression. Endoscopic sphincterotomy relieved abdominal pain in 86% of the patients who underwent the procedure. Evaluation of medical treatment, particularly ursodeoxycholic acid, is necessary.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Cholangitis/diagnosis , HIV Infections/complications , HIV Seropositivity/complications , HIV , Adult , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis/etiology , Cholangitis/therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Time FactorsABSTRACT
Acalculous cholecystitis and sclerosing cholangitis due to Cryptosporidium sp, and cytomegalovirus have been described in patients with the acquired immunodeficiency syndrome (AIDS). However, in about 40% of cases of AIDS-related biliary disease, no opportunistic pathogen is identified. The current case report describes the first case, to the best of the authors' knowledge, of AIDS-related sclerosing cholangitis associated with microsporidiosis. Enterocytozoon bieneusi was detected in the duodenum and bile by means of light microscopy and confirmed by electron microscopy. Microsporidian infection should be suspected in patients with AIDS-related sclerosing cholangitis as well as in cases of diarrhea in which none of the usual pathogens are found.