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Sustained abnormal bilirubin and leukocyte levels after ERCP with acute suppurative obstructive cholangitis: a case report with 2 months follow-up observation

Year: 2026

Type: article

Abstract: Acute Suppurative Obstructive Cholangitis (AOSC) typically resolves post-ERCP. However, a 53-year-old male had persistent hyperbilirubinemia and leukocytosis (WBC 28.12×10 9 /L) along with marked eosinophilia (20.26×10 9 /L) despite standard antibiotic therapy. Systematic diagnosis ruled out residual calculi, Endoscopic Nasobiliary Drainage (ENBD) dysfunction, biliary neoplasms, and sclerosing cholangitis. A history of undercooked freshwater fish consumption and eosinophilia prompted suspicion of occult liver fluke infection, despite negative initial stool tests. Diagnostic treatment with albendazole resulted in a decrease in WBC and eosinophil counts; subsequent detection of liver flukes in ENBD fluid and positive liver fluke IgG confirmed the diagnosis. At 2-month follow-up, all markers normalized. This case highlights the diagnostic value of eosinophilia in guiding the identification of parasitic infections in refractory post-ERCP inflammation, and the utility of diagnostic therapy when direct evidence is lacking.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1726277

Authors: Jie Zheng, Jiahao Mo, Jintang Xiong, Jiaming He, Lu Wang, Yan Chen

Institutions: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801