Clinical Significance of Subacute Nonsuppurative Cholangitis: A Study of 25 Cases
Laura De La Cruz, Bita V Naini, Hanlin L Wang. University of California Los Angeles, Los Angeles, CA
Background: Subacute nonsuppurative cholangitis (SNC) is a unique type of cholangitis, characterized by ductular reaction with inspissated bile plugs in dilated ductules. The few studies on a limited number of cases have suggested an association between SNC and sepsis and/or intraabdominal infection. However, we believe this is an under-recognized finding in liver biopsies. Our goal in this study was to histologically evaluate a larger number SNC cases and to correlate the diagnosis with various clinical parameters.
Design: Pathology database was searched retrospectively to identify liver biopsies that carried the potential diagnosis of SNC using various histologic descriptions and diagnostic terms. Seventy cases were identified spanning a period of 12 years. Twenty-five cases fulfilled the histologic criteria for SNC. Clinical information was obtained from electronic medical records.
Results: Twenty-two patients were liver transplant recipients; 21 were transplanted within 1-12 months, and one transplanted 14 years ago. Twenty-two (88%) patients, including all 3 non-transplant patients, had clinical presentations of sepsis at the time of the liver biopsy or shortly thereafter. Four patients (16%) had intraabdominal infection with abscess formation. Twenty patients (80%) had positive bacterial cultures from bile, blood and/or sputum reported from days prior to days following the liver biopsy. None of the cases had evidence of large bile duct obstruction or vascular abnormality by imaging studies. Follow-up liver biopsies were available in 5 patients. Four had follow-up biopsies within 2-4 weeks, which all showed minimal histologic improvement. One patient had a repeat biopsy 97 days later, which showed areas of infarction and pronounced canalicular cholestasis in addition to continued features of SNC. Thirteen patients (52%) died shortly after the initial biopsy with no follow-up biopsies.
Conclusions: Our study examined the largest number of SNC cases and our findings support the notion that SNC in a liver biopsy is associated with the presence of sepsis and/or intraabdominal infection. In addition, our data show that the histologic features of SNC can stay for a prolonged period of time and that patients with SNC bear a poor prognosis. Familiarity with this entity and recognition of the association with sepsis/intraabdominal infection may help avoid unnecessary clinical work-up and/or incorrect management, especially in the transplant setting where there is generally a broad list of differential diagnosis for abnormal liver tests.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 158, Tuesday Afternoon