A Rare Case of Pediatric Obstructive Jaundice Linked to Eosinophilic Cholangiopathy

Introduction

Obstructive jaundice in pediatric patients is a clinically significant condition with a wide range of possible causes, from congenital anomalies to inflammatory and infectious disorders. However, rare benign conditions can closely mimic malignancy, making diagnosis particularly challenging. One such condition is eosinophilic cholangiopathy, an uncommon inflammatory disorder of the biliary system.
This blog highlights key insights from a rare pediatric case that underscores the importance of accurate diagnosis and conservative management. Visit https://www.gastrohepatoljournal.com/index.php/acgh for more groundbreaking research and peer-reviewed findings in gastroenterology and hepatology.

Understanding Eosinophilic Cholangiopathy

Eosinophilic cholangiopathy is characterized by dense eosinophilic infiltration of the biliary tract and, in some cases, the pancreas and gallbladder. Although benign, its presentation often resembles serious conditions such as biliary malignancy.

Key Clinical Features

• Obstructive jaundice
• Abdominal pain and fever
• Peripheral eosinophilia
• Elevated serum IgE levels
• Radiological findings suggestive of biliary obstruction or pancreatic mass

These overlapping features frequently lead to misdiagnosis, emphasizing the need for careful clinical correlation.

Case Summary: A Rare Pediatric Presentation

An 11-year-old boy presented with jaundice, fever, abdominal pain, and darkcolored urine. Previous surgical history and imaging findings initially raised concerns for malignancy. However, further evaluation revealed:

• Marked peripheral eosinophilia
• Elevated IgE levels
• MRI with MRCP showing biliary dilatation and pancreatic head mass
• Histopathological evidence of eosinophilic infiltration

Based on these findings, a diagnosis of eosinophilic cholangiopathy with pancreatitis was established.

A detailed analysis can be found in our main journal article

Management and Treatment Outcomes

Unlike malignant biliary conditions, eosinophilic cholangiopathy responds well to medical therapy.

Treatment Highlights

• Oral corticosteroids (prednisolone 1 mg/kg)
• No invasive procedures such as ERCP or repeat biopsy required
• Significant clinical and biochemical improvement
• Resolution of jaundice and normalization of eosinophil counts

This outcome reinforces the importance of recognizing this condition early to avoid unnecessary surgical intervention.

Clinical Significance and Broader Implications

This case demonstrates how eosinophilic disorders can masquerade as serious hepatobiliary malignancies, particularly in children. Awareness among clinicians is essential for timely diagnosis and optimal management.

Organizations such as the American Gastroenterological Association (AGA) emphasize evidence-based diagnostic strategies to differentiate inflammatory biliary disorders from malignant conditions, ensuring patients receive appropriate and less invasive care.

Why This Case Matters

• Highlights a rare but treatable cause of obstructive jaundice
• Emphasizes the value of histopathology and laboratory correlation
• Supports the role of steroid therapy in eosinophilic biliary diseases
• Prevents unnecessary surgical and endoscopic procedures

Access the Full Study

The complete case report and diagnostic details are available at:
https://doi.org/10.29328/journal.hcg.1001001

For ongoing updates, reviews, and clinical insights, explore gastrohepatoljournal as a trusted source for gastroenterology and hepatology research.

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