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1) NAME OF ARTICLE/TEACHING FILE 
Progressive HIV-associated Cholangiopathy in an HIV Patient Treated with Combination Antiretroviral Therapy.


2) HTTP OF THE ARTICLE/TEACHING FILE
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088554/


3) PATIENT HISTORY

A 37-year-old Japanese man, who has sex with men and presenting with neurosyphilis, pneumococcal pneumonia, and HIV infection. The patient had no history of drug use or alcoholism. 


4) TYPE OF IMAGE

MRI of liver


5) REPORTED DIAGNOSIS AND/OR CASE FINDINGS 

Given the findings, the patient's liver dysfunction was suspected to be HIV-associated cholangiopathy.


6) EXPLANATION OF CASE FINDINGS/PERTINENT FACTS

He was started on a cART regimen of tenofovir, emtricitabine, and darunavir according to Japan's national protocol for AIDS therapy. The HIV viral load became undetectable after 4 months of therapy, and the CD4 cell count increased to over 200 cells/μL within 2 months of cART initiation. Following the increase in the CD4 cell count, the patient's hepatic and biliary enzyme levels normalized immediately. The elevation of T-bil was not observed in his clinical course. Therefore, they eventually diagnosed the patient's liver dysfunction to be HIV-associated cholangiopathy.


7) RESOURCE USED

Imai K., Misawa K., Matsumura T., Fujikura Y., Mikita K., Tokoro M., Maeda T., Kawana A. (2016). Progressive HIV-associated Cholangiopathy in an HIV Patient Treated with Combination Antiretroviral Therapy. Internal Medicine, 55(19), 2881-2884. doi:10.2169/internalmedicine.55.6826

APPEARANCE OF PATHOLOGY ON RADIOGRAPHS/IMAGES

An external file that holds a picture, illustration, etc. Object name is 1349-7235-55-2881-g001.jpg

Figure 1: Magnetic resonance imaging shows an intrahepatic bile duct stricture and pruned-tree appearance, mainly in the anterior segment of the right hepatic lobe (a, b). Magnetic resonance imaging at 15 months after the initiation of cART shows further focal dilatation in the intrahepatic bile duct (arrowhead) (c, d).