Eosinophilic cholangitis: A benign condition masquerading as biliary malignancy

Eosinophilic cholangitis is a rare, benign condition of the biliary tract that often causes obstructive jaundice and poses a significant diagnostic challenge due to its close resemblance to malignancy. It should be considered when imaging shows a biliary stricture, especially if malignancy cannot be definitively diagnosed preoperatively, alongside peripheral eosinophilia and the absence of typical malignancy symptoms. We present a rare case of a young male with painless obstructive jaundice caused by a biliary stricture in the distal common bile duct, masquerading as biliary malignancy and ultimately diagnosed as idiopathic hypereosinophilic syndrome with eosinophilic cholangitis. The case underscores the diagnostic and therapeutic challenges involved and highlights the importance of a multidisciplinary approach and strict adherence to treatment protocols to achieve a favorable outcome. • Eosinophilic cholangitis can masquerade as biliary malignancy with raised tumor marker levels. • A multidisciplinary approach and strict adherence to treatment protocols are important to achieve a favorable outcome. • In a patient with obstructive jaundice due to a distal biliary tract stricture, it is crucial to rule out other uncommon benign causes.