P1339 - A Rare Case of Oriental Cholangitis Also Known as Hong Kong Disease in the United States.

Charitha Karanam Ramapathy, MBBS, Rakesh Kanipakam, MD, Binay Kshetree, MD
Baptist Medical Center South, Montgomery, AL

Introduction: Recurrent pyogenic cholangitis (RPC) also known as Honk Kong disease or oriental cholangitis is a chronic infection with recurrent bacterial cholangitis. It causes recurrent bouts of cholangitis as Charcot’s triad of right upper quadrant pain, fever and jaundice. RPC is mainly a result of biliary stasis from obstruction of biliary tree with a stone in biliary duct resulting in a stricture formation. It is seen in people of East and Southeast Asian origin. Incidence has risen in West with increasing immigration but overall incidence has been decreasing with better quality of healthcare.

Case Description/Methods: Patient is a 64-year-old Korean lady with history of liver abscess presented with 4 days’ of nausea, abdominal pain and fevers. 15 years ago, she had gallstones removed but had persistent similar episodes that required cholecystectomy. She is originally from Korea and lived in Japan for several years. Blood work showed elevated white blood count to 15,000/uL and elevated ALT at 89 unit/L & AST at 69 unit/L. CT abdomen/pelvis with contrast showed an ill-defined mass in the right hepatic lobe, intra and extrahepatic biliary dilation containing air. MRI AP w/wo MRCP revealed findings consistent with cholangitis, dilated CBD and hepatic abscess. Patient had ultrasound guided abscess drainage and a liver biopsy which was negative for malignancy. Blood cultures remained negative both aerobic and anaerobic bottles. Stool was negative for Abscess fluid cultures grew streptococcus constellatus. Patient did not receive any drain since the abscess was mostly solid, and improved with antibiotics.

Discussion: Recurrent pyogenic cholangitis (RPC) can lead to life threatening complications like sepsis, abscess at liver and distant sites including lungs and brain, pus filled bile ducts rupture into peritoneum or fistula formation and cholangiocarcinoma (CCA). RPC requires a multidisciplinary approach with infectious disease team, surgical team, gastroenterology and interventional radiology teams with a focus on minimizing or preventing complications and fix the source of infection to avoid recurrence including hepatectomy. A study from Korea evaluated the risk of CCA among patient with RPC and had significant results among patients who had partial hepatectomy. This is an attempt to explain the importance of considering Recurrent pyogenic cholangitis among all Asian immigrants with biliary tract disease.



Disclosures:


Charitha Karanam Ramapathy, MBBS, Rakesh Kanipakam, MD, Binay Kshetree, MD. P1339 - A Rare Case of Oriental Cholangitis Also Known as Hong Kong Disease in the United States., ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.