Primary sclerosing cholangitis revealed during pregnancy: case report

Primary sclerosing cholangitis (PSC) is a cholangiopathy characterized by chronic fibroinflammatory damage of the biliary tree and is frequently associated with inflammatory bowel disease (IBD). Its association with pregnancy is exceptional and presents unique diagnostic and therapeutic challenges. We report a case of PSC revealed during pregnancy. It’s about a 30-year-old woman, gravida 1, para 0, with no significant medical history, presented at 16 weeks of pregnancy with intense pruritus and persistent fatigue. Laboratory findings revealed cholestasis with elevated alkaline phosphatase, gamma-glutamyl transferase, and transaminases. An abdominal ultrasound ruled out cholelithiasis, while MRCP demonstrated multifocal bile duct strictures, suggestive of PSC with a chronic liver disease. The patient was managed with Ursodeoxycholic acid and close multidisciplinary monitoring. Delivery occurred at term without major complications, and postpartum follow-up was established to monitor disease progression. This case highlights the importance of considering PSC in atypical gestational cholestasis and underscores the need for a multidisciplinary approach to optimize maternal-fetal management.