Objective. Symptoms and laboratory data between acute cholangitis (AC) patients treated with and AC patients treated without immunosuppressive drugs (corticosteroids or methotrexate) were compared to identify factors that can be meaningful to the diagnosis of AC. Methods. The Wilcoxon signed-rank test was used for comparison of baseline variables between the patients with AC treated with immunosuppressive drugs and those without it. The chi-squared test was used in the analysis of the symptoms. Results. In total, 69 patients with AC were enrolled. Fifteen patients were treated with immunosuppressants due to rheumatoid arthritis or other collagen diseases. Jaundice was less frequent in the patients treated with immunosuppressive drugs ( ). T-Bil level was marginally lower in the patients treated with immunosuppressants ( ). AST and ALT levels were lower in the patients treated with immunosuppressants ( and 0.022, respectively). Conclusions. The frequency of jaundice and AST and ALT levels were lower in the patients treated with immunosuppressive drugs. It is recommended that care be taken to evaluate jaundice, AST level, and ALT level in the diagnosis of AC. 1. Introduction Acute cholangitis (AC) is a bacterial infection caused by obstruction of the bile duct [1–3]. AC should be treated promptly because it can be fatal owing to sepsis [4, 5]. Biliary drainage is performed by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography, or endoscopy-guided ultrasonography [6]. The prompt and accurate diagnosis of AC is a necessity. The diagnosis of AC is based on the presence of inflammation and biliary obstruction [7, 8]. Laboratory data are indispensable for the diagnosis of AC. These include the following: white blood cell (WBC) count and C-reactive protein (CRP), total bilirubin (T-Bil), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase (γ-GTP) levels [6, 9]. Some AC patients are simultaneously being treated for a collagen disease such as rheumatoid arthritis [10]. Collagen diseases are treated with immunosuppressive drugs that consist of corticosteroids, methotrexate (MTX), and, recently, biological agents such as etanercept. Corticosteroids include prednisolone and methylprednisolone. AST and ALT levels increase subsequent to the administration of a combination of corticosteroids and other immunosuppressive drugs [11]. The distribution of changes is not different between immunosuppressants. MTX antagonizes folate and inhibits DNA
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