^99mTc-trimethyl-BrIDA Scintigraphy in HIV-related Cholangiopathy

Summary

A HIV-infected 37-year-old man with diffuse mid-abdominal pain and elevated liver enzymes was sequentially studied by sonography, computed tomography (CT), ^99mTc-trimethyl-BrlDA scintigraphy and endoscopic retrograde cholangiopancreatography (ERCP). CT and sonography did not lead to a final diagnosis. Cholescintigraphy showed signs of cholecystitis and sclerosing cholangitis with intra- and extrahepatic bile duct dilatation. These findings could be confirmed by ERCP, rendering HIV-associated cholepathy probable. Cytomegalovirus infection was demonstrated by polymerase chain reaction from bile fluid and the presence of Cryptosporidia infection in a histology specimen isolated by ERCP. Therefore, biliary scintigraphy seems promising for screening for HIV-associated cholangio-and cholecystopathy, being less invasive and less bothering for the patient than ERCP.

Zusammenfassung

Ein 37jähriger Mann mit diffusen Schmerzen im mittleren Abdomen wurde mittels Sonographie, Computertomographie (CT), ^99mTc-trimethyl-BrlDA-Szintigra-phie und endoskopischer retrograder Cholangiographie (ERCP) untersucht. Sowohl die sonographische als auch die computertomographische Untersuchung führte zu keiner endgültigen Diagnose. Die hepatobiliäre Funktionsszintigraphie zeigte den Befund einer Cholezystitis und sklerosierenden Cholangitis mit Dilatation der intra- und extrahepatischen Gallengänge. Die konsekutiv durchgeführte ERCP konnte dies bestätigen und machte eine HlV-assoziierte Cholepathie wahrscheinlich. Eine Cytomegalievirusinfektion wurde durch eine Polymerase-Ketten-reaktion mittels Galleflüssigkeit und eine Infektion mit Cryptosporidien durch eine Biopsie der Gallengänge gesichert. Die hepatobiliäre Funktionsszintigraphie scheint eine geeignete nichtinvasive Screeningmethode zum Nachweis einer HlV-assoziierten Cholangio- und Cholezystopathie zu sein.

Keywords

HIV-related cholangiopathy - Cryptosporidia and cytomegalovirus infection - biliary scanning - ERCP

Schlüsselwörter

HIV-induzierte Cholangiopathie - Cryptosporidien- und Cytomegalievirusinfektion - hepatobiliäre Szintigraphie - ERCP

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