Persistent Cholestatic Hepatitis after Choledocholithiasis Removal: A Rare Case of Vanishing Bile Duct Syndrome

Vanishing bile duct syndrome (VBDS) is a rare condition involving the progressive loss of intrahepatic bile ducts.

A 77-year-old woman presented with cholestatic hepatitis, initially diagnosed with choledocholithiasis and treated via ERCP; however, her persistent transaminase levels did not improve. A subsequent liver biopsy revealed ductopenia, consistent with VBDS. She had been on long-term amoxicillin for maintenance therapy related to recurrent infections from sacral decubitus ulcers. Amoxicillin was determined to be the most likely offending agent behind VBDS and was discontinued. After the withdrawal of the culprit medication, the case was monitored for nearly 3 years, and the patient's transaminase levels consistently trended downward with ursodeoxycholic acid before she ultimately passed away from complications arising from other comorbidities.

This case served as a rare and valuable example of amoxicillin contributing to VBDS, and with cessation of the offending drug and supportive care with ursodeoxycholic acid, it can lead to gradual biochemical improvement after a prolonged follow-up course.