Department of Internal medicine, Chungbuk National University College of Medicine, Cheongju-si, Republic of Korea
ABSTRACT
A 48-year-old woman visited the emergency room for abdominal pain and fever. She had undergone large common bile duct (CBD) stone extraction with endoscopic retrograde cholangiopancreatography (ERCP) ten times in the previous 14 months. We initially thought that the rapid, recurrent bile duct stone production was due to the dilatation of the CBD diameter, so we had planned a hepaticojejunostomy. However, the serum white blood cell count at 11th visit was 113,500/μ, and computed tomography showed multiple CBD stones. To resolve the cholangitis, ERCP with lithotripsy was performed. A peripheral blood smear and bone marrow biopsy revealed acute myeloid leukemia, and induction chemotherapy was started. Risk factors for recurrent CBD stones include biliary stasis due to anatomical problems, systemic disease such as hemolytic anemia, and altered immune mechanism and bacterial overgrowth. We report a patient in whom bile duct stones recurred over several months before the onset of acute leukemia.
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