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Mycophenolate mofetil for drug-induced vanishing bile duct syndrome

S-Simona Jakab1, A-Brian West, Dennis-M Meighan

  • 1Norwalk Hospital, Section of Gastroenterology, 24 Stevens Street, Norwalk, CT 06856, United States.

World Journal of Gastroenterology
|November 21, 2007
PubMed

Insights

Amoxicillin/clavulanate can cause prolonged liver injury. Mycophenolate mofetil effectively treated a patient with vanishing bile duct syndrome, allowing corticosteroid withdrawal.

Area of Science:

  • Hepatology
  • Clinical Pharmacology

Background:

  • Amoxicillin/clavulanate is a common cause of drug-induced liver injury, typically cholestatic.
  • While often self-limiting, severe or protracted cases can occur, necessitating treatment considerations.

Observation:

  • An elderly patient presented with prolonged cholestasis following amoxicillin/clavulanate use.
  • Liver biopsies confirmed vanishing bile duct syndrome, a severe form of cholestatic liver injury.

Findings:

  • Initial treatment with prednisone provided partial response but failed to allow corticosteroid weaning.
  • Addition of azathioprine did not facilitate corticosteroid withdrawal.
  • Mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor, enabled complete withdrawal of prednisone and azathioprine.

Implications:

  • This case highlights mycophenolate mofetil as a potential therapeutic option for refractory drug-induced vanishing bile duct syndrome.
  • It suggests a role for immunosuppressive therapy in managing severe, protracted cholestatic liver injury from amoxicillin/clavulanate.
  • Further research is warranted to explore the efficacy and safety of mycophenolate mofetil in similar cases.

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