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Reappearance of vanished bile ducts
R A Chamuleau1, M J Diekman, P J Bos
1Dept. of Internal Medicine, University of Amsterdam, The Netherlands.
Hepato-Gastroenterology
|December 1, 1992
Summary
A severe toxic epidermal necrolysis case led to blindness and liver cholestasis. Remarkably, bile ducts reappeared, resolving liver issues but leaving vision impaired.
Area of Science:
- Dermatology
- Ophthalmology
- Hepatology
Background:
- Presents a rare case of severe toxic epidermal necrolysis (TEN) in a 36-year-old woman.
- The TEN was of unknown origin and led to significant ocular and hepatic complications.
Observation:
- Skin lesions healed without scarring, but ocular lesions progressed to symblepharon and corneal opacification, causing near-total blindness.
- Severe intrahepatic cholestasis developed, initially suspected to be vanished bile duct syndrome, with other liver diseases excluded.
Findings:
- The intrahepatic cholestasis spontaneously improved after six months.
- A liver biopsy after 51 weeks revealed the reappearance of bile ducts, indicating resolution of the cholestasis.
Implications:
- This case highlights a unique and previously unreported sequence of TEN complications and recovery.
- Suggests potential for spontaneous regeneration of bile ducts in severe cholestasis, offering insights for liver disease management.
- Underscores the long-term visual impairment risks associated with TEN, necessitating specialized ophthalmic care.