Cryptogenic Acute Cholangitis—Association with Toxic Shock Syndrome

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Abstract
The clinical and pathologic findings of eight cases of cryptogenic acute cholangitis are reported. Six of the patients had clinical features of toxic shock syndrome (TSS) and all but one died. No patient had antecedent disease of the liver or gall bladder. Blood cultures for bacteria from six of the patients were negative. Postmortem cultures from two patients grew Staphylococcus aureus. The biliary tract was patent and the pancreas was grossly normal in every case. The major histologic finding was acute cholangitis, with minimal or no cholestasis, but changes were noted in many other organs. It is suggested that the acute cholangitis could account for the jaundice and hyperbilirubinemia that is reported in about half the patients with TSS. Damage to bile ducts by a circulating toxin rather than bacterial infection is suggested as the pathogenetic mechanism.