Secondary sclerosing cholangitis: an unusual presentation of leptospirosis

TL;DR

This paper reports the first case of secondary sclerosing cholangitis caused by leptospirosis in a patient without other major complications.

Contribution

The first documented case linking leptospirosis to secondary sclerosing cholangitis.

Findings

A 37-year-old patient with leptospirosis developed sclerosing cholangitis confirmed by MRI.

Leptospirosis was identified as the cause after ruling out other potential factors.

This case highlights the need to consider cholangitis in leptospirosis patients with cholestasis.

Abstract

Sclerosing cholangitis is a rare progressive cholestatic disease that is classified as secondary sclerosing cholangitis when it is caused by an identifiable cause. Sclerosing cholangitis has been linked to infections like COVID-19 and parasitic infections like Clonorchis sinensis and Ascaris lumbricoides. However, leptospirosis has not been linked to sclerosing cholangitis in the medical literature. In this article, we report a 37-year-old gentleman who was diagnosed with leptospirosis, worsened by painless cholestasis, while he was improving from leptospirosis. Magnetic resonance cholangiopancreatography revealed multiple short-segment biliary strictures, segmental dilatation, and mural irregularities in both intrahepatic ducts confirming the diagnosis of sclerosing cholangitis. After ruling out other potential causes and considering the initial presentation during a leptospirosis infection, we concluded that leptospirosis caused secondary sclerosing cholangitis. We report this as the first case of secondary sclerosing cholangitis in a leptospirosis patient without renal, respiratory, or cardiac complications, emphasizing the importance of ruling out this cause in a leptospirosis patient with persistent cholestasis.

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