Mycophenolate mofetil for drug-induced vanishing bile duct syndrome  

作　　者：S Simona Jakab A Brian West Dennis M Meighan Robert S Brown Jr William B Hale 

机构地区：[1]Section of Gastroenterology, Norwalk Hospital, Norwalk, CT 06856,United States [2]Department of Pathology, New York UniversityNew York, NY, United States [3]Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, United States

出　　处：《World Journal of Gastroenterology》2007年第45期6087-6089,共3页世界胃肠病学杂志（英文版）

摘　　要：Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment, but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil.Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment, but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil.

关 键 词：Amoxicillin and clavulanate Drug-inducedcholestasis Ductopenia Mycophenolate mofetil Vanishingbile duct syndrome 

分 类 号：R575.6[医药卫生—消化系统]