Parth Patel, DO1, Neil Sondhi, MD2, Ajantha Rangasamy, MD1, Antonios Tsompanidis, DO3, John Dedousis, MD3 1Bayonne Medical Center, Bayonne, NJ; 2CarePoint Health, Bayonne, NJ; 3Carepoint Health, Bayonne, NJ
Introduction: Giardia Lamblia is traditionally an infection of the small bowel, specifically the duodenum. Giardial involvement of the biliary tree is a rare manifestation that has been recorded in immunocompromised individuals. We present a case of likely biliary giardiasis causing acalculous cholangitis in an immunocompetent patient.
Case Description/Methods: A 58 yo F with a PMH of GERD presented to the ED with a 3-day hx of constant noncolicky substernal pain radiating to the back. Pt reported a one-month hx of daily abdominal distress and postprandial loose stools. She had an EGD and colonoscopy performed two weeks prior, but results of the procedure were unknown. On presentation, the pt had fever, leukocytosis, and elevated transaminases. An abdominal ultrasound along with a CT abdomen and pelvis were notable for colitis involving the descending colon. Pt was started on antibiotics. Morning labs showed worsening leukocytosis, ALT – 750, AST – 1010, and Alk-phos – 144. An MRCP was performed; it showed no signs of a passing stone or significant biliary sludge. On day three of admission, results of previous EGD were ascertained yielding that the pt had duodenal giardiasis. Patient was continued on metronidazole and an ERCP was scheduled for a brush biopsy of the biliary tree to determine if Giardia had colonized and spurred the cholangitis. Brush biopsies were inconclusive for G. lamblia growth, as our lab could not provide the appropriate growth medium. By the fourth day of admission, the pt’s began to experience symptom relief.
Discussion: Acalculous Cholangitis is a common entity and very infrequently due to amoebic etiologies. G. lamblia is an intestinal protozoan parasite with a prevelence of 2-5% in developed countries. In this case, the pt denied recent travel to an underdeveloped country. However, she was being treated for GERD with a PPI. Cases of Giardiasis in adults living in developed countries can be seen in the immunocompromised, but can also be seen in hypochlorhydric patients. G. Lamblia typically colonizes and causes inflammation of the duodenum. There are few previous reports of acalculous cholecystitis and biliary cholangitis secondary to G. Lamblia, specifically in immunocompetent individuals. We propose that even in immunocompetent patients Giardia may involve any part of the GI tract. This should be strongly considered in patient's being treated with PPI or H2 antagonists. Thus, in individuals with acalculous cholangitis and concomitant diarrhea we recommend ERCP with brush biopsies.
Disclosures: Parth Patel indicated no relevant financial relationships. Neil Sondhi indicated no relevant financial relationships. Ajantha Rangasamy indicated no relevant financial relationships. Antonios Tsompanidis indicated no relevant financial relationships. John Dedousis indicated no relevant financial relationships.
Parth Patel, DO1, Neil Sondhi, MD2, Ajantha Rangasamy, MD1, Antonios Tsompanidis, DO3, John Dedousis, MD3. P1103 - Giardia-Induced Acalculous Cholangitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.