Temporal Association of Infection to Ductular Cholestasis in Liver Biopsies
Adam J Darnell, Romil Saxena. Indiana University, Indianapolis, IN
Background: Severe infections and septicemia are known to result in ductular (cholangiolar) cholestasis which is characterized by dilated ductules containing bile casts present at edges of portal tracts. However, it is not known how long these changes persist after infection or if they precede clinical or laboratory detection of infection.
Design: Liver biopsies showing ductular cholestasis were identified by a free text search of the pathology database for various combinations of the words “cholangiolar” and “ductular” with “cholestasis” and “casts”. Cases with another prominent pathological process identified histologically (i.e., acetaminophen toxicity, neoplasm, allograft rejection) were excluded. Electronic medical records were examined for evidence of infection, source of positive culture, cultured organism and timing of positive culture from biopsy.
Results: 14 cases were identified; there were 7 males and 7 females ranging from 22 to 76 years (mean 50 years). The biopsies were performed for elevated liver enzymes. Underlying clinical diagnoses included solid organ transplantation (5 cases), idiopathic liver failure (2 cases), malignancy (3 cases) and miscellaneous conditions (4 cases). 12 of the 14 cases had either clinically suspected or laboratory identified infections, from 1 day to 2 months after biopsy; 1 case did not have laboratory evidence of infection, but clinically died from septic shock 3 days after the biopsy. 1 case showed no clinical or laboratory evidence of infection.
Positive cultures were most commonly obtained from blood (6/12 cases) followed closely by urine (5/12 cases). Gram negative rods were the most common microorganism, led by E. coli. Other organisms isolated included; E. cloacae, P. aeruginosa, K. pneumoniae, E. faecium, C. tropicalis, and C. glabrata.
Conclusions: Ductular cholestasis was associated with clinical or laboratory evidence of infection in 12/14 cases (86%). However, this evidence could be demonstrated within 7 days of biopsy in only 7/12 (58%) cases. Although the remaining 5 cases had evidence of infection, the causal relationship in these cases is doubtful when positive cultures are detected many days after the biopsy.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 240, Wednesday Morning