Management of Medical Fitness in Idiopathic Adulthood Ductopenia in Aviation Medicine: A Case Report

Abstract

Aims: The case raises important considerations regarding aeronautical fitness especially in managing chronic diseases, as Moroccan regulations and International Civil Aviation Organization (ICAO) standards necessitate strict health evaluations for air traffic controllers (ATC) as they play a crucial role in flight safety. Case Presentation: We present the case of a 26-year-old female Moroccan air traffic controller who was asymptomatic but presented with abnormal liver function tests during her periodic medical assessment. Comprehensive investigations, led to a diagnosis of idiopathic adulthood ductopenia (IAD) Discussion: IAD is a rare cholestatic liver disease of unknown etiology, characterized by biopsy-confirmed ductopenia without an identifiable cause. It manifests in two forms: mild (Type 1), with limited bile duct loss and a favorable prognosis, and severe (Type 2), which often progresses to biliary cirrhosis. Ursodeoxycholic acid (UDCA) has shown efficacy in mild cases, although its long-term impact remains uncertain. Moroccan aviation standards, in alignment with ICAO guidelines, generally deem serious gastrointestinal conditions disqualifying. However, exemptions may be granted based on medical stability, treatment response, and flight safety considerations. In this case, the mild nature of IAD, absence of complications, and positive response to UDCA warranted an exemption with regular monitoring. Conclusion: This case emphasizes the importance of the systematic periodic medical assessment including liver function tests, for aircrew and by extension ATC. It also underscores the need for nuanced management of chronic conditions within the aviation field.