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. (AU)