title: Vanishing bile duct syndrome associated with elevated pancreatic enzymes after short-term administration of amoxicillin.
abstract: Amoxicillin is a widely used antibiotic, rarely being considered a cause of hepatic injury. We report the case of a 45-year-old woman who developed a vanishing bile duct syndrome 8 weeks after initiation of amoxicillin therapy. Liver biopsy showed destruction and loss of preformed bile ducts together with an inflammatory infiltrate involving eosinophilic leucocytes. Cholestasis was progressive despite prednisolone treatment and was accompanied by elevation of pancreatic enzymes. The patient died after 18 months from progressive liver failure. This case illustrates that amoxicillin alone can be a cause of progressive and ultimately fatal vanishing bile duct syndrome.
authors.affiliation: Department of Internal Medicine, University of Bonn, Germany.
authors.forename: Carolynne
authors.initials: C
authors.lastname: Schwarze
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Fischer
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spengler
mesh_terms: D000658:Amoxicillin / Q000009:adverse effects*; D002779:Cholestasis / Q000139:chemically induced*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced* / Q000473:pathology; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000201:enzymology; D010406:Penicillins / Q000009:adverse effects*
chemical_list: D010406:Penicillins; D000658:Amoxicillin