Liver & intrahepatic bile ducts

Biliary tract disease

Cholangitis lenta / sepsis

Editor-in-Chief: Debra L. Zynger, M.D.
Raul S. Gonzalez, M.D.

Topic Completed: 10 December 2020

Minor changes: 6 May 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Cholangitis lenta OR cholangiolar cholestasis

Raul S. Gonzalez, M.D.
Page views in 2020: 1,174
Page views in 2021 to date: 1,289
Cite this page: Gonzalez RS. Cholangitis lenta / sepsis. website. Accessed December 8th, 2021.
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
  • Additional terms include cholangiolar cholestasis or subacute nonsuppurative cholangitis (Am J Surg Pathol 2017;41:1607)
  • “Lenta” appears to mean “slow”
  • Cause of biliary abnormalities in septic patients is complex, likely multifactorial (Crit Care 2012;16:235)
Case reports
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.
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Ductular cholestasis in sepsis

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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
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 following finding:

    What is the most likely diagnosis?

  1. Acetaminophen toxicity
  2. Alpha-1 antitrypsin deficiency
  3. Primary biliary cholangitis
  4. Sepsis
Board review style answer #1
Board review style question #2
    The term typically used by pathologists to refer to bile ductular cholestasis is

  1. Biliary cholangitis
  2. Cholangitis lenta
  3. Fibrosing cholestatic hepatitis
  4. Obstructive cholestasis
Board review style answer #2
B. Cholangitis lenta

Comment Here

Reference: Cholangitis lenta / sepsis
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