Novel use of hepatobiliary scintigraphy for the diagnosis of interleukin-2 cholangiopathy.

We report a case of interleukin-2 (IL-2) induced cholangiopathy diagnosed with the aid of hepatobiliary scintigraphy. Patient was a 32 years old, male with history of metastatic melanoma. Computed tomography (CT) upon admission demonstrated worsening of patient's metastatic lung disease with a normal appearance of the gallbladder. The patient was started on high dose IL-2 treatment for regression of his disease. Four days after IL-2 treatment was begun, the patient developed severe right upper quadrant pain and elevated liver function tests. A right upper quadrant ultrasound and surgical consultation were requested. Sonographic findings demonstrated diffuse gallbladder wall thickening, mural edema, a positive sonographic Murphy's sign, but no gallstones. The preliminary working diagnosis was acalculous cholecystitis versus IL-2 induced cholangiopathy. To clarify between these two entities, a hepatobiliary scan was obtained that demonstrated filling of the gallbladder with prompt biliary-to-bowel transit and normal liver function. In this case, the clinical presentation and history of recent IL-2 treatment were suggestive of IL-2 cholangiopathy, though the patient's co-morbidities and in-patient status raised concern for acalculous cholecystitis. Given the marked differences in treatment, hepatobiliary imaging was requested and found to be normal, making acalculous cholecystitis very unlikely. In conclusion, we believe this is the first case in which hepatobiliary scintigraphy was used to aid in the diagnosis of IL-2 induced cholangiopathy.