Vanishing bile duct syndrome in a child with toxic epidermal necrolysis: an interplay of unbalanced immune regulatory mechanisms.
Vanishing bile duct syndrome (VBDS) is a rare disorder and requires a liver biopsy for a diagnosis. The condition has not been reported in children with toxic epidermal necrolysis (TEN). The etiology of VBDS in our patient with TEN is most likely from drug hypersensitivity. A high index of suspicion will prompt clinicians to start more specific investigations and treatments. The use of immunosuppressive agents, intravenous immunoglobulin and ursodeoxycholic acid has not been consistently successful in these patients. A new approach with biologic agents such as anti-tumor necrosis factor-alpha may be a promising therapy and reduce severe adverse outcomes.
Karnsakul
Wikrom
W
Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV 26506-9214, USA. wakarnsakul@hsc.wvu.edu
Arkachaisri
Thaschawee
T
Atisook
Kanit
K
Wisuthsarewong
Wanee
W
Sattawatthamrong
Yudhtana
Y
Aanpreung
Prapun
P
D000890:Anti-Infective Agents / Q000009:adverse effects*; D001649:Bile Duct Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000276:immunology / Q000473:pathology; D002648:Child; D004342:Drug Hypersensitivity / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000209:etiology / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination