An episode of acute cholangitis in a department of internal medicine: an unusual case.

Diagnosis of acute cholangitis (AC) is clinical. A definitive diagnosis cannot be established only on the basis of laboratory tests. Thus, a history of biliary tract disease and clinical presentation are important to reach the diagnosis. Pathogenesis of AC is represented by an infection of the biliary tract associated with a partial or complete obstruction of the biliary system due to various causes (bile duct lithiasis, benign or malignant stenosis, malfunction of biliary-enteric anastomosis, etc.). Here we reported the case of a 69-year-old man with recurrent postoperative (laparoscopic cholecystectomy) biliary stricture-related mild acute cholangitis, with presence of biliary sludge in the common bile duct, previously diagnosed by gastroenterologists as acute drug-induced hepatotoxicity. After broad-spectrum antibiotic i.v. therapy the patient subsequently underwent endoscopic retrograde cholangio-pancreatography (ERCP), with stent placement, and symptoms and laboratory abnormalities disappeared.