Case Report
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2007; 13(45): 6087-6089
Published online Dec 7, 2007. doi: 10.3748/wjg.v13.i45.6087
Mycophenolate mofetil for drug-induced vanishing bile duct syndrome
S Simona Jakab, A Brian West, Dennis M Meighan, Robert S Brown Jr, William B Hale
S Simona Jakab, Dennis M Meighan, William B Hale, Section of Gastroenterology, Norwalk Hospital, Norwalk, CT 06856, United States
A Brian West, Department of Pathology, New York University, New York, NY, United States
Robert S Brown Jr, Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: William B Hale, MD, Norwalk Hospital, Section of Gastroenterology, 24 Stevens Street, Norwalk, CT 06856, United States.
Telephone: +1-203-8522278 Fax: +1-203-8522075
Received: March 31, 2007
Revised: July 28, 2007
Accepted: September 5, 2007
Published online: December 7, 2007

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.

Keywords: Amoxicillin and clavulanate, Drug-induced cholestasis, Ductopenia, Mycophenolate mofetil, Vanishing bile duct syndrome