# 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.

## Key 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.