Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://www.journalmc.org

Case Report

Volume 13, Number 9, September 2022, pages 462-470

Acquired Immune Deficiency Syndrome Cholangiopathy: Case Series of Three Patients and Literature Review

Figures

Figure 1.
Figure 1. Preserved reticulin network with focal regenerative pattern on reticulin stain.
Figure 2.
Figure 2. CK7 highlighting ductular reaction and scattered intermediate hepatocytes.
Figure 3.
Figure 3. Trichome stain demonstrating pericellular and portal fibrosis without definite bridging.
Figure 4.
Figure 4. Preserved reticulin network on reticulin stain.
Figure 5.
Figure 5. Lympho-monocytic infiltrate admixed with plasma cells on H&E. H&E: hematoxylin and eosin.
Figure 6.
Figure 6. Portal tracts expansion by fibrosis with septa formation and focal bridging on trichome staining.
Figure 7.
Figure 7. Major papilla among edematous mucosa and erythema.
Figure 8.
Figure 8. Minimal or no contrast on the film seen after maximal contrast injection.

Tables

Table 1. Laboratory Workup for Case 1
 
Laboratory testValue reportedReference range
White blood cell (WBC)144.3 - 11 × 103/µL
Platelets72150 - 400 × 103/µL
CD4 count18463 - 1,685/µL
Alkaline phosphatase (ALP)34546 - 116 U/L
Gamma glutamyl transferase (GGT)12515 - 85 U/L
Alanine aminotransferase (AST)29215 - 37 U/L
Albumin2.33.4 - 5 g/dL
Internationalized ratio (INR)1.090.8 - 1.2
Serum ascites albumin gradient (SAAG)0.9< 1.1

 

Table 2. Laboratory Workup for Case 2
 
Laboratory testValue reportedReference range
Platelets83150 - 400 × 103/µL
CD4 count241463 - 1,685/µL
Alkaline phosphatase (ALP)65346 - 116 U/L
Gamma glutamyl transferase (GGT)41915 - 85 U/L
Total bilirubin9.00.2 - 1.0 mg/dL
  Direct bilirubin7.30 - 0.2 mg/dL
Albumin1.23.4 - 5 g/dL
Serum ascites albumin gradient (SAAG)0.9< 1.1

 

Table 3. Laboratory Workup for Case 3
 
Laboratory testValue reportedReference range
Hemoglobin8.112 - 16 g/dL
Platelets23150 - 400 × 103/µL
Human immunodeficiency virus viral load119,386< 20 copies/mL
CD4 count38463 - 1,685/µL
Total bilirubin7.30.2 - 1.0 mg/dL
  Direct bilirubin6.30 - 0.2 mg/dL
Alkaline phosphatase (ALP)39446 - 116 U/L
Gamma glutamyl transferase (GGT)40215 - 85 U/L
Albumin2.13.4 - 5 g/dL

 

Table 4. Summary of Cases
 
PresentationAbdominal pain and tenderness on abdominal exam; Diarrhea; Jaundice3/3 (100%) patients; 2/3; 1/3
HIV: human immunodeficiency virus; ALP: alkaline phosphatase; AIDS: acquired immune deficiency syndrome; PCR: polymerase chain reaction; CMV: cytomegalovirus; MRCP: magnetic resonance cholangiopancreatography; ERCP: endoscopic retrograde cholangiopancreatography; ART: antiretroviral therapy.
Laboratory dataCholestatic pattern of liver injury with ALP3/3 (100%)
HIV statusAdvanced AIDS; CMV by PCR; Cryptosporidium parvumAll three patients; All three patients; 1/3 patients
ImagingAbdominal ultrasound; MRCP; ERCPNo biliary abnormalities noted; 2/3 within normal limit; 1/3 with abnormal findings
HistopathologyLiver biopsyFindings of cholangitis in 2/3 patients
TreatmentART; Treatment of opportunistic infection2/3 patients; 2/3 patients
PrognosisTwo patient’s non-adherent to ART and third case was a new diagnosisOne patient with good response to ART and alive at 30 months; Second and third patients expired within a month of diagnosis despite treatment