A patient with AIDS may develop a sclerosing cholangitis secondary to one or more causes.


Potential causes:

(1) cytomegalovirus (CMV)

(2) Cryptosporidium

(3) Microsporidium

(4) Mycobacterium avium-intracellulare

(5) tumor (Kaposi sarcoma, non-Hodgkin's lymphoma)


Clinical features:

(1) presence of AIDS

(2) pain and tenderness in the right upper quadrant

(3) low grade fever

(4) elevated serum alkaline phosphatase (>= 2 times the upper limit of normal)

(5) variable elevation of total serum bilirubin

(6) evidence of 2 or more biliary lesions on ERCP or ultrasound

(7) exclusion of gallstones and inflammatory bowel disease


Biliary lesions may include:

(1) irregular thickening of the walls

(2) patchy dilatation

(3) strictures

(4) papillary stenosis


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