A case of hyperbilirubinemia during treatment with chenodeoxycholic acid

This is a report of a 27-year-old female with hyperbilirubinemia during treatment with chenodeoxycholic acid (CDCA) for the resolution of gallstones. After CDCA administration, serum bilirubin increased markedly without an apparent obstruction of bile ducts. The histological findings of the liver were compatible with toxic liver injury. Bile acids analysis, however, did not reveal the increment of lithocholic acid, toxic metabolite of CDCA in the serum and the hepatic tissue. The bile acids sulfation and the 6 alpha-hydroxylation of CDCA were also normal. Her jaundice disappeared quickly after discontinuation of CDCA. Presumably, in this case, the stagnation of bile acids in the liver caused by choledochal sands facilitated the toxic effect of CDCA on the damaged hepatocytes.