“…1,3,4,6 The underlying pathogenesis is not fully elucidated, but destructive cholangitis has been associated with possible idiosyncratic drug reactions (potentiated sulfonamides, amoxicillin-clavulanate, amitraz, and milbemycin oxime), toxic insults (paraquat, and 4,4' diaminodiphenylmethane), and canine distemper virus infection. 3,5,6 As this case presented with elevated liver enzyme concentrations and hyperbilirubinemia prior to medication administration, the underlying cause of destructive cholangitis in this case was undetermined. Destructive cholangitis carries a poor prognosis: of the 10 reported cases, 7 survived 7 weeks or less, 2 survived 1 year and 6 months (at the time of publication), and 1 had an unknown survival time.…”