Low Phospholipid-Associated Cholelithiasis Syndrome: A Case Report of Chronic Recurrent Cholangitis Post-Cholecystectomy Course.

Low phospholipid-associated cholelithiasis (LPAC) syndrome is a rare and underdiagnosed cause of recurrent intrahepatic and extrahepatic bile duct stones. We report the case of a 32-year-old male with a history of laparoscopic cholecystectomy and multiple ERCPs who presented with acute epigastric pain and vomiting. He had recurrent episodes of cholangitis over several months, each managed with ERCP, balloon extraction, and biliary stenting. Imaging revealed biliary dilatation with obstructive stones. Emergency ERCP retrieved a large stone with pus and debris, followed by stent placement and clinical improvement. He was diagnosed with LPAC syndrome and discharged on ursodeoxycholic acid. Follow-up imaging demonstrated persistent but improving biliary dilation without structural anomalies or abscesses. This case underscores the recurrent nature of LPAC syndrome and the importance of considering this diagnosis in young adults with unexplained biliary symptoms post-cholecystectomy. Early recognition and long-term management are essential to reduce recurrence.