PROLONGED CLINICAL REMISSION IN CHOLANGIT IS ASSOCIATED WITH EARLY HIV-INFECTION AFTER SURGICAL BILIARY DECOMPRESSION

During the acquired immunodeficiency syndrome, most cases of cholangit is develop at an advanced stage of disease. We report a case of cholan gitis in a 47-year-old homosexual man, stage IIa according to Center o f Disease Control classification. An isolated jaundice was the first m anifestation of the disease. The number of CD4 was 380/mu L. Ultrasono graphy and endoscopic retrograde cholangiography showed a 7 cm stenosi s of the common bile duct, and cystic duct stenosis, with associated i ntra-hepatic biliary duct dilatation. No infectious agent was found. C holecystectomy and hepaticojejunostomy were performed. Pathological ex amination of liver biopsy and a sample of the resected common bile duc t was consistent with sclerosing cholangitis. The postoperative course was uneventful. During a three year follow-up period, the patient was disease free but he suddenly died of uncontrolled bleeding from duode nal ulcer. In HIV-infected patients, surgical treatment can be perform ed in case of symptomatic long stenosis of the common bile duct.