P3085 - Liver Arteritis: An Uncommon Etiology of Ischemic Cholangiopathy With Primary Sclerosing Cholangitis-like Histologic Features

Dorsay Sadeghian, MD¹, Sadhna Dhingra, MD², Saira Khaderi, MD, MPH¹, Shilpa Jain, MD^1
1Baylor College of Medicine, Houston, TX; ²Houston Methodist, Houston, TX

Introduction: Ischemic cholangiopathy is a condition characterized by focal or diffuse damage to bile duct, resulting from impaired blood supply, which may exhibit variable histologic features. While this concept is well described in post-liver transplant patients, other causes of small hepatic artery injury may lead to ischemia and bile duct damage. Although it is extremely uncommon, involvement of liver as part of systemic or isolated vasculitis can lead to microvasculature damage.

Case Description/Methods: We are describing a case of ischemic cholangiopathy attributed to isolated liver arteritis, in a 49 y/o lady presented with increase in alkaline phosphatase (1237 U/L) and gamma-glutamyl transferase (700 U/L), along with elevated erythrocyte sedimentation rate and C-reactive protein. Microscopic examination of liver biopsy revealed portal tracts with edema, mild lymphocytic infiltration, and peri-ductal fibrosis, mimicking sclerosing cholangitis. There was no interface hepatitis, ductular reaction or ductopenia (Figure A-C). Focus of necrotizing granulomatous arteritis, zone 3 sinusoidal dilatation and hepatocyte atrophy were seen.




Further evaluation of the patient revealed no positive serologic markers. Magnetic resonance cholangiopancreatography showed unremarkable intra- and extrahepatic bile ducts. Immunosuppressive treatment resulted in significant alkaline phosphatase decrease, and partial resolution of histologic features upon follow-up biopsy (Figure D)

Discussion: In conditions with chronic blood supply disruption such as arteritis, histologic features may resemble pathologies with permanent bile duct damage. In reversible scenarios like arteritis, a precise diagnosis and intervention can potentially avert enduring complications such as ductopenia and fibrosis. This case report sets the groundwork for further research on the link between vasculitis and liver injury.



Disclosures:


Dorsay Sadeghian, MD¹, Sadhna Dhingra, MD², Saira Khaderi, MD, MPH¹, Shilpa Jain, MD¹. P3085 - Liver Arteritis: An Uncommon Etiology of Ischemic Cholangiopathy With Primary Sclerosing Cholangitis-like Histologic Features, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.