Charcot Triad: Definition, History, Symptoms and Risk Factors

It refers to the set of 3 signs and symptoms that lead to the suspicion of the diagnosis of 2 different diseases:

  • Multiple sclerosis
  • Colangitis.


The term comes from the French neurologist Jean-Martin Charcot (1825-1893), who described this combination of signs related to each disease for the first time.

In 1877, Charcot described cholangitis as a triad of upper right quadrant (RUQ) pain, fever, and jaundice. The Reynolds pentad adds mental state changes and sepsis to the trio.

A spectrum of cholangitis ranges from mild symptoms to overwhelming fulminating sepsis. With septic shock, the diagnosis can be overlooked in up to 25% of patients.

Consider the possibility of cholangitis in any patient who appears septic, especially in patients who are elderly, jaundiced, or have abdominal pain. A history of abdominal pain or colic symptoms of the gallbladder may be a clue to the diagnosis.


Symptoms include:

  • Jaundice.
  • Fever.
  • Abdominal pain.
  • Itching.
  • Acrylic or hypoechoic stools.
  • Discomfort.

Charcot’s triad consists of fever, RUQ pain, and jaundice. It is reported in 50-70% of patients with cholangitis. However, recent studies believe it is more likely to be present in 15-20% of patients.


Fever is present in approximately 90% of cases.

It is believed that abdominal pain and jaundice occur in 70% and 60% of patients.

Patients have an altered mental state of 10-20% of the time and hypotension of approximately 30%. These signs, combined with Charcot’s triad, constitute the Reynolds pentad.

Consequently, many patients with ascending cholangitis do not present the classic signs and symptoms.

Most patients complain of pain in the right upper quadrant; However, some patients, especially the elderly, are too ill to locate the source of infection.

Charcot identified two medical triads: the Charcot Multiple Sclerosis Triad and the Cholangitis Triad. Both identify very different diseases and disorders and should not be confused.

The Charcot triad for Multiple Sclerosis identifies three medical signs that highlight the possible injury or involvement of the brainstem:

  1. Nystagmus (the uncontrolled movement of the eyes in a lateral direction).
  2. Intentional trembling
  3. Changes in the tone of the voice.

It is essential to recognize that although these three signs indicate multiple sclerosis, they are not definitive for diagnosis.

Charcot’s triad for ascending cholangitis identifies three medical signs:

  1. Jaundice (yellow tint on the skin).
  2. Fever, usually with rigors (tremors).
  3. Abdominal pain in the upper right quadrant.

The Charcot triad for ascending cholangitis results from ascending cholangitis (an infection of the bile duct often caused by E-coli).

Risk factors:

The patient’s medical history can be helpful. For example, a history of the following increases the risk of cholangitis:

  • Gallstones, CBD stones.
  • Recent cholecystectomy.
  • Endoscopic manipulation or ERCP, cholangiography.
  • History of cholangitis

History of HIV or AIDS: AIDS-related cholangitis is characterized by extrahepatic biliary edema, ulceration, and obstruction. The etiology is uncertain but may be related to cytomegalovirus or Cryptosporidium infections.