Liver & intrahepatic bile ducts
Biliary tract disease
Cholangitis lenta / sepsis
Author: Raul S. Gonzalez, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Last author update: 10 December 2020
Last staff update: 15 July 2022
Copyright: 2002-2025, PathologyOutlines.com, Inc.
PubMed Search: Cholangitis lenta OR cholangiolar cholestasis
Table of Contents
Definition / general | Essential features | Terminology | Pathophysiology | Laboratory | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Gonzalez RS. Cholangitis lenta / sepsis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livercholangitislenta.html. Accessed April 2nd, 2025.
Definition / general
- Cholangitis lenta was originally a term referring to a rare clinical form of chronic sepsis (Hum Pathol 1982;13:19)
- Now typically used by pathologists to refer to microscopic bile ductular cholestasis (Am J Surg Pathol 2017;41:1607), often in the context of sepsis
Essential features
- Cholangitis lenta currently functions as a synonym for bile ductular cholestasis
- Ductular reaction with bile ductular cholestasis is concerning (but not specific) for sepsis
Terminology
- Additional terms include cholangiolar cholestasis or subacute nonsuppurative cholangitis (Am J Surg Pathol 2017;41:1607)
- Lenta appears to mean slow
Pathophysiology
- Cause of biliary abnormalities in septic patients is complex, likely multifactorial (Crit Care 2012;16:235)
Laboratory
- Positive microbiology cultures common (Am J Surg Pathol 2017;41:1607)
- Bilirubin levels often high (Lefkowich: Scheuer's Liver Biopsy Interpretation, 9th Edition, 2015)
Case reports
- Child with sepsis and hepatorenal syndrome (Fetal Pediatr Pathol 2018;37:424)
Microscopic (histologic) description
- Dilated, peripherally located bile ductular reaction that contains inspissated bile
- Other common findings include portal tract inflammation, duct injury, hepatocyte ballooning or necrosis and canalicular cholestasis (Am J Surg Pathol 2017;41:1607)
Microscopic (histologic) images
Contributed by Raul S. Gonzalez, M.D.
Ductular cholestasis in sepsis
Ductular cholestasis in cirrhosis
Sample pathology report
- Liver, biopsy:
- Biliary pattern injury with ductular reaction, prominent ductular cholestasis and moderate portal inflammation (see comment)
- Comment: The clinical concern for liver failure is noted. The histologic findings raise the possibility of sepsis, though they are not specific for that diagnosis.
Differential diagnosis
- Ductular cholestasis can be seen in:
- Sepsis:
- Histology not entirely specific, with other biliary pattern injury and inflammation often seen; clinical correlation needed
- Neonatal alpha-1 antitrypsin deficiency:
- PASD positive protein globules in hepatocytes
- Extrahepatic biliary atresia:
- Biliary pattern injury in young patients; clinical correlation needed
- Cirrhosis:
- Cause of cirrhosis not necessarily biliary
- Post transplant liver biopsies:
- Occurs in both adult and pediatric patients (Am J Surg Pathol 2017;41:1607, Transplantation 1998;65:692)
- Clinical correlation needed
- Sepsis:
Board review style question #1
A patient presents with jaundice and general malaise. Workup indicates acute liver failure, along with an elevated white blood cell count. Liver biopsy shows the findings in the image above. What is the most likely diagnosis?
- Acetaminophen toxicity
- Alpha-1 antitrypsin deficiency
- Primary biliary cholangitis
- Sepsis
Board review style answer #1
Board review style question #2
What is the term typically used by pathologists to refer to bile ductular cholestasis?
- Biliary cholangitis
- Cholangitis lenta
- Fibrosing cholestatic hepatitis
- Obstructive cholestasis
Board review style answer #2
