Year 2024 / Volume 116 / Number 3
Letter
Secondary sclerosing cholangitis induced by systemic chemotherapy

173-174

DOI: 10.17235/reed.2023.9653/2023

Ángela Antón Rodriguez, Aitor Odriozola Herrán, Víctor José Echavarría Rodríguez, Sara Alonso Fernández,

Abstract
There are multiple causes of secondary sclerosing cholangitis (SSC), including mechanical obstruction, ischemia, congenital abnormalities, cholangiopathy of the critically ill patient and rarely, chemotherapy (1,2). We present the case of a 52-year-old female with a history of left breast invasive ductal carcinoma treated with neoadjuvant chemotherapy (adriamycin, cyclophosphamide and paclitaxel), surgery and radiotherapy in March 2021. She was admitted in July 2022 due to painless jaundice and pruritus with marked serum cholestasis. Magnetic resonance cholangiopancreatography showed multiple strictures and dilatations involving the intra and extrahepatic bile ducts (Figure 1.A), without any extrinsic stenotic cause. Findings were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy (Figure 1.B). Biopsies were negative for malignancy and IgG4 disease. In addition, autoantibodies were negative and serum IgG4 levels were normal. Due to these findings and the history of recent chemotherapy, the patient was diagnosed with paclitaxel-induced sclerosing cholangitis, initiating treatment with ursodeoxycholic acid. Over the following two months, she suffered two episodes of Klebsiella Pneumoniae bacteraemia due to acute cholangitis. Dilatation and placement of plastic stents in both biliary trees were performed and prophylactic antibiotherapy was started. The patient had a poor evolution and was not candidate for liver transplantation on account of a recent neoplasia. She died six months later due to sepsis secondary to multiple hepatic abscesses.
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References
1. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on sclerosing cholangitis. J Hepatol. 2022 Sep;77(3):761-806. doi: 10.1016/j.jhep.2022.05.011. Epub 2022 Jun 21. PMID: 35738507.
2. Imam MH, Talwalkar JA, Lindor KD. Secondary sclerosing cholangitis: pathogenesis, diagnosis, and management. Clin Liver Dis. 2013 May;17(2):269-77. doi: 10.1016/j.cld.2012.11.004. Epub 2012 Dec 20. PMID: 23540502.
3. Kusakabe A, Ohkawa K, Fukutake N, Sakakibara M, Imai T, Abe Y, Takada R, Ikezawa K, Nawa T, Ashida R, Kimura T, Nagata S, Katayama K. Chemotherapy-Induced Sclerosing Cholangitis Caused by Systemic Chemotherapy. ACG Case Rep J. 2019 Jul 17;6(7):e00136. doi: 10.14309/crj.0000000000000136. PMID: 31620533; PMCID: PMC6722363.
4. Matsuo T, Nakamura Y, Suzuki K. [A case of secondary sclerosing cholangitis caused by chemotherapy with nab-paclitaxel]. Nihon Shokakibyo Gakkai Zasshi. 2015 May;112(5):888-95. Japanese. doi: 10.11405/nisshoshi.112.888. PMID: 25947025.
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Antón Rodriguez Á, Odriozola Herrán A, Echavarría Rodríguez V, Alonso Fernández S. Secondary sclerosing cholangitis induced by systemic chemotherapy. 9653/2023


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Publication history

Received: 10/04/2023

Accepted: 18/04/2023

Online First: 12/05/2023

Published: 04/03/2024

Article Online First time: 32 days

Article editing time: 329 days


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