A 35-year-old female from Southeast Asia presented to ER multiple times with RUQ abdominal pain, nausea, and fever. She was found to be septic. The patient has a history of obstructive jaundice.

Ultrasound revealed intrahepatic biliary duct dilation with multiple intra-hepatic biliary calculi. ERCP demonstrated similar findings.

The clinical history and imaging findings are consistent with recurrent pyogenic cholangitis, previously known as oriental cholangiohepatitis.

Case courtesy Dr Abdelhamed Elgargani MD.