Idiopathic adulthood ductopenia with elevated transaminase only: A case report

Zhang, Xiaochen; Wang, Di; Li, Xiang; Hu, Yuanqi; Wang, Chong

doi:10.12998/wjcc.v8.i24.6524

Cited by 3 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, some cases have no identifiable aetiology, a phenomenon previously recognized as idiopathic adulthood ductopenia but now better known as vanishing bile duct syndrome (VBDS) 3,4 . These conditions typically present with chronic cholestasis, although isolated transaminitis has been reported 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 These conditions typically present with chronic cholestasis, although isolated transaminitis has been reported. 5,6 Drug-induced liver injury (DILI) can be divided into hepatitic, cholestatic or mixed hepatitic and cholestatic patterns clinically. Microscopically, DILI varies from necroinflammatory injury, cholestatic injury, steatosis or steatohepatitis, fibrosis with cirrhosis, vascular lesions and neoplasia to other rare patterns.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cloxacillin‐induced acute vanishing bile duct syndrome: A case study and literature review

Faragalla

Lau

Wang

et al. 2022

Brit J Clinical Pharma

View full text Add to dashboard Cite

Ductopenia is often regarded as a chronic process where ≥50% of portal tracts lack bile ducts, which is also known as vanishing bile duct syndrome (VBDS). One aetiology is drug‐induced liver injury. Cloxacillin, an antistaphylococcal penicillin, typically causes “bland” cholestasis. We present the first case of cloxacillin‐induced acute ductopenia or VBDS and a review of published cloxacillin‐induced liver injuries. A 66‐year‐old woman with no prior liver disease, but known penicillin allergy, was treated for postcarotid angioplasty staphylococcal infection with 6 weeks of cloxacillin. She presented with a 2‐week history of weakness and jaundice. Laboratory work‐up showed elevated liver enzymes with a cholestatic pattern, hyperbilirubinemia and eosinophilia. She required ICU transfer for hypotension and was started empirically on prednisone. Liver biopsy revealed severe centrilobular cholestasis, mild necroinflammation and ductopenia with epithelial injury, but no ductular reaction. Two months later she was discharged on hydrocortisone and ursodiol with persistently elevated alkaline phosphatase and bilirubin. She was considered for liver transplantation but died of liver failure 4 months later. Four additional articles were found with histopathologic descriptions of cloxacillin‐related liver injury. These included portal inflammation, cholestasis and mild necroinflammation. Clinical features were reported in two cases; both had mild symptoms with cholestatic liver enzymes and hyperbilirubinemia. Both patients recovered completely within 10‐60 days. Cloxacillin‐induced cholestasis can be secondary to acute ductopenia, which can result in worse clinical outcomes than previously described “bland” cholestasis. Liver biopsy is recommended to identify cases with acute VBDS.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cloxacillin‐induced acute vanishing bile duct syndrome: A case study and literature review

Faragalla

Lau

Wang

et al. 2022

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…However, some cases have no identifiable etiology, a phenomenon previously recognized as idiopathic adulthood ductopenia but now better known as vanishing bile duct syndrome (VBDS) [3][4] . These conditions typically present with chronic cholestasis, although isolated transaminitis has been reported [5][6] .…”

Section: Introductionmentioning

confidence: 99%

Cloxacillin-induced acute vanishing bile duct syndrome: a case study and literature review

Faragalla

Lau

Wang

et al. 2022

Preprint

View full text Add to dashboard Cite

Ductopenia is often regarded as a chronic process where ≥50% of portal tracts lack bile ducts, which is also known as vanishing bile duct syndrome (VBDS). One etiology is drug-induced liver injury. Cloxacillin, an anti-staphylococcal penicillin, typically causes “bland” cholestasis. We present the first case of cloxacillin-induced acute ductopenia or VBDS and a review of published cloxacillin-induced liver injuries. A 66-year-old woman with no prior liver disease, but known penicillin allergy, was treated for post-carotid angioplasty staphylococcal infection with 6 weeks of cloxacillin. She presented with a two-week history of weakness and jaundice. Laboratory work-up showed elevated liver enzymes, hyperbilirubinemia, and eosinophilia. She required ICU transfer for hypotension and was started empirically on prednisone. Liver biopsy revealed severe centrilobular cholestasis, mild necroinflammation, and ductopenia with epithelial injury, but no ductular reaction. Two-months later, she was discharged on hydrocortisone and ursodiol with persistently elevated alkaline phosphatase and bilirubin. She was considered for liver transplantation but died of liver failure four months later. Four additional articles were found with histopathologic descriptions of cloxacillin-related liver injury. These included portal inflammation, cholestasis and mild necroinflammation. Clinical features were reported in two cases; both had mild symptoms with cholestatic liver enzymes and hyperbilirubinemia. Both patients recovered completely within 10-60 days. Cloxacillin-induced cholestasis can be secondary to acute ductopenia, which can result in worse clinical outcomes than previously described “bland” cholestasis. Liver biopsy is recommended to identify cases with acute VBDS.

show abstract

Bicyclol

Tang¹,

Li²

2021

Reactions Weekly

View full text Add to dashboard Cite

Idiopathic adulthood ductopenia with elevated transaminase only: A case report

Cited by 3 publications

References 8 publications

Cloxacillin‐induced acute vanishing bile duct syndrome: A case study and literature review

Cloxacillin‐induced acute vanishing bile duct syndrome: A case study and literature review

Cloxacillin-induced acute vanishing bile duct syndrome: a case study and literature review

Bicyclol

Contact Info

Product

Resources

About