An Uncommon Cause of Cholangitis and Cholecystitis

Blood tests revealed normal blood cell counts, mild elevation of C-reactive protein (31.0 mg/L), cholestasis (alkaline phosphatase 479 U/L, γ-GT 1,111 U/L) and hyperbilirubinemia (9.6 mg/dL). Subsequently, endoscopic ultrasound was performed and revealed inflamed (diffuse ductal wall oedema) and dilated common bile duct and cystic duct, both filled by an elongated and rounded structure with a double-tubular core (Fig. 1), and multiple enlarged hilar lymph nodes. According to the diagnosis of cholangitis, an endoscopic retrograde cholangiopancreatography was performed.