title: Mycophenolate mofetil for drug-induced vanishing bile duct syndrome.
abstract: 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.
authors.affiliation: Norwalk Hospital, Section of Gastroenterology, 24 Stevens Street, Norwalk, CT 06856, United States.
authors.forename: S-Simona
authors.initials: SS
authors.lastname: Jakab
authors.forename: A-Brian
authors.initials: AB
authors.lastname: West
authors.forename: Dennis-M
authors.initials: DM
authors.lastname: Meighan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: William-B
authors.initials: WB
authors.lastname: Hale
mesh_terms: D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001649:Bile Duct Diseases / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D009173:Mycophenolic Acid