Resumo

RODRIGUES, Susana et al. Caso II: adulto do sexo masculino, 20 anos, com diarreia não-sanguinolenta. Arq Med [online]. 2012, vol.26, n.2, pp.78-87. ISSN 2183-2447.

Hepatobiliary diseases are common extraintestinal manifestations of inflammatory bowel disease (IBD). In fact, abnormal liver biochemical tests are present in up to 30 percent of patients with IBD, do not appear to correlate with disease activity or severity and may be associated with a specific concomitant disease (autoimmune or not) or therapy. As a result, persistently abnormal liver biochemical tests should generally be carefully evaluated. Primary sclerosing cholangitis (PSC) is one of the more common hepatobiliary complications of IBD, particularly in patients with ulcerative colitis (UC), particularly extensive colitis. We describe a case of a 20-year male patient diagnosed with extensive ulcerative colitis and persistently elevated liver biochemical tests. During the workup the patient presented persistent cholestatic (gGT, ALP 3-4x ULN) and cytosolic liver injury (AST, ALT 2.5x ULN), with a predominance of cholestasis. His etiological workup revealed an elevated IgG and positive ANCAp. The liver biopsy performed did not show clear signs of an anatomo-clinical entity responsible for the hepatobiliary disease. The patient was treated with oral mesalamine, azathioprine and ursodeoxycholic acid (UDCA) with a partial response. A cholangio-MRI showed an extra-hepatic biliary stricture and the endoscopic retrograde cholangiopancreatography (ERCP) revealed a 3cm stricture and findings highly suggestive of intra-hepatic PSC. Biliary biopsies taken showed signs of atypia questioning the possible presence of malignancy, and subsequent optimization of therapy

Palavras-chave : Diarreira não sanguinolenta; Doença de Crohn; Doença inflamatória intenstinal.

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