Cholangiolitic Hepatitis: Clinical-Pathologic Studies and Response to Steroid Therapy in Four Cases

Introduction  A chronic form of hepatitis, which was predominantly obstructive, was originally recognized by Eppinger.¹ Watson and Hoffbauer² later used the term "cholangiolitic hepatitis" in referring to patients with a similar clinical picture. In addition, other reports,^3-6 substantiated by epidemiological data, have indicated that acute viral hepatitis is capable of inducing an illness with clinical and laboratory features typical of regurgitation jaundice. In cholangiolitic hepatitis the clinical manifestation of a relative sense of well-being is in marked contrast to the biochemical abnormalities. There are usually an appreciable degree of pruritus (associated with acholic stools), low urinary urobilinogen, hyperbilirubinemia (high direct fraction), bilirubinuria, high alkaline phosphatase, and hypercholesteremia. This is in marked contrast to the relatively normal "flocculation" tests. A review of the previously described cases disclosed many with mildly abnormal hepatocellular tests, and the diagnosis of cholangiolitic hepatitis was used to indicate these predominant clinical and biochemical