Cholangitis, Lymphocytic

Also known as lymphocytic-plasmacytic cholangitis or cholangiohepatitis, lymphocytic portal hepatitis and non-suppurative cholangitis or cholangiohepatitis.

Signalment

Young to middle-aged cats, 50% under 4 years old.

Description

Lymphocytic cholangitis is a slowly progressive chronic disease characterised by infiltration of the portal areas of the liver with inflammatory cells, mostly lymphocytes and plasma cells. Bile duct hypertrophy and fibrosis are present, however, lymphocytic cholangitis does not progress to biliary cirrhosis. An immune-mediated aetiology has been postulated, however, this has not been substantiated to date. It is rarely associated with pancreatitis.

Diagnosis

Clinical Signs

• History of chronic waxing and waning low-grade illness.
• Vague clinical signs which may include
  • anorexia
  • depression
  • weight loss
  • intermittent vomiting and diarrhoea
  • jaundice
  • lymphadenomegaly
• Severe illness and pyrexia less likely compared to Neutrophilic Cholangitis.
• Some cats in the UK are polyphagic and are frequently presented with ascites and/or jaundice.

Haematology & Biochemistry

• Increased ALP, increased ALT, hyperbilirubinaemia, hyperglobulinaemia
• Neutrophilia is less common than with acute cholangitis

Imaging

• Radiographic signs are non specific. Hepatomegaly due to enlargement of biliary ducts and ascites in some cases.
• Ultrasonography is more helpful and biliary tract dilation can be seen in all cases. Common bile duct is normally dilated and the gallbladder may also be dilated with "sludge". Main differential is extrahepatic biliary obstruction.

Biopsy

Liver biopsy is important to rule out FIP. It is vital to obtain haemostasis profile prior to biopsy due to risk of prolonged coagulation with liver disease.

Treatment

Glucocorticoid at immunosuppressive dose of 1-4 mg/kg BID for 6-12 weeks

Prognosis

Good