P0158 - A Case of a Biliary Stricture Secondary to Periportal Lymphadenopathy Following Rabies Vaccination Series

William Ghaul, DO¹, Neil Patel, DO¹, Amanda Jacubowsky, DO¹, Timothy Graziano, DO¹, Chandler Patton, DO¹, Shashin Shah, MD^2
1Lehigh Valley Health Network, Allentown, PA; ²Eastern Pennsylvania Gastrointestinal and Liver Specialists, Allentown, PA

Introduction: Biliary strictures can be a challenging diagnosis. Work-up includes basic lab work, abdominal imaging, and even invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP). Although up to 30% of strictures are benign, the majority are malignant in the form of pancreatic adenocarcinoma and cholangiocarcinoma. As a result, a multidisciplinary approach is vital to differentiate between the two.

Case Description/Methods: A 30-year-old male with no past medical history presented with a rash, fatigue, and jaundice for one week. Of note, the patient was exposed to a bat in his home that had tested positive for rabies. He had subsequently completed the 3 vaccine series five days prior to arrival. Denied alcohol use, drug use, recent travel, new medications/supplements, or high-risk sexual behavior. On arrival, AST 165, ALT 372, total bilirubin 9.2, and direct bilirubin 6.6. Serological and infectious work-up unrevealing. MRCP showed focal narrowing of common hepatic duct. ERCP/EUS showed reactive periportal lymphadenopathy causing compression of common hepatic duct. The stricture was dilated and the patient received 2 biliary stents in left and right hepatic duct. Subsequent liver biopsy consistent with cholestatic hepatitis. Surgical pathology following stent removal negative for malignancy. Liver function tests normalized on outpatient follow-up.

Discussion: The exact incidence of biliary strictures is unknown. In individuals with accompanying obstructive jaundice, the stricture should be considered malignant unless proven otherwise. Common etiologies of benign biliary strictures include iatrogenic (post-procedure), chronic pancreatitis, and primary sclerosing cholangitis. Rarely in the literature is reactive lymphadenopathy a cause of obstruction. This case highlights the importance of a thorough history and physical, as well as prompt imaging to establish a diagnosis.


Disclosures:


William Ghaul, DO¹, Neil Patel, DO¹, Amanda Jacubowsky, DO¹, Timothy Graziano, DO¹, Chandler Patton, DO¹, Shashin Shah, MD². P0158 - A Case of a Biliary Stricture Secondary to Periportal Lymphadenopathy Following Rabies Vaccination Series, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.