Biliary Tract Obstruction in the Acquired Immunodeficiency Syndrome

Three patients with the acquired immunodeficiency syndrome had biliary obstruction resulting from benign strictures of the biliary tract. Stenosis of the distal common bile duct with differing degrees of irregularity of the smaller intrahepatic and extrahepatic ducts was seen in association with either Cryptosporidia! or cytomegaloviral infection of the biliary tree. We review cytomegaloviral and Cryptosporidia! infections of the biliary system, as well as possible relationships with idiopathic primary sclerosing cholangitis. Stenotic biliary tract disease appears to be yet another complication of the acquired immunodeficiency syndrome. S E V E R A L GASTROINTESTINAL complications of the ac-quired immunodeficiency syndrome (AIDS) have been reported including cryptosporidiosis, cytomegalovirus infections, and candidiasis, as well as an unexplained en-teropathy not attributable to presently recognized patho-gens (1). Cases of patients with cholecystitis and Cryp-tosporidia or cytomegalovirus in the gallbladder have been reported (2-4), but clinically significant biliary tract obstruction unrelated to gallstones, malignant disease, or previous surgery has not been widely recognized. Three patients with AIDS recently presented with cho-lestasis and extrahepatic biliary obstruction. Hepatobili-ary cryptosporidiosis or cytomegaloviral infections were well documented in each. Stenotic biliary tract disease appears to be yet another complication of this syndrome