title: Vanishing bile duct syndrome associated with azithromycin in a 62-year-old man.
abstract: Vanishing bile duct syndrome is a severe cholestatic disease associated with toxic effects of medications. Stevens-Johnson syndrome is a hypersensitivity disorder that may also be caused by medications. We present a case of a 62-year-old male patient who developed vanishing bile duct syndrome a month after Stevens-Johnson syndrome. These adverse drug reactions were associated with the use of azithromycin (500 mg daily for 3 days). The patient was initially treated for Stevens-Johnson syndrome with steroids, antihistamines and proton pump inhibitors and fully recovered. However, a month after the beginning of Stevens-Johnson syndrome, he developed vanishing bile duct syndrome and was treated with steroids, ursodeoxycholic acid, antihistamines and tacrolimus. Unfortunately, the treatment was unsuccessful and he was listed for liver transplantation which was performed 7 months after the beginning of jaundice. This is the first case of vanishing bile duct syndrome associated with the use of azithromycin and one of few that reports vanishing bile duct syndrome and Stevens-Johnson syndrome co-occurrence.
authors.affiliation: Division of Clinical Pharmacology, Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia. danica.juricic@gmail.com
authors.forename: Danica
authors.initials: D
authors.lastname: Juricic
authors.forename: Juricic
authors.initials: J
authors.lastname: Danica
authors.forename: Irena
authors.initials: I
authors.lastname: Hrstic
authors.forename: Hrstic
authors.initials: H
authors.lastname: Irena
authors.forename: Davor
authors.initials: D
authors.lastname: Radic
authors.forename: Radic
authors.initials: R
authors.lastname: Davor
authors.forename: Mate
authors.initials: M
authors.lastname: Skegro
authors.forename: Skegro
authors.initials: S
authors.lastname: Mate
authors.forename: Marijana
authors.initials: M
authors.lastname: Coric
authors.forename: Coric
authors.initials: C
authors.lastname: Marijana
authors.forename: Boris
authors.initials: B
authors.lastname: Vucelic
authors.forename: Vucelic
authors.initials: V
authors.lastname: Boris
authors.forename: Igor
authors.initials: I
authors.lastname: Francetic
authors.forename: Francetic
authors.initials: F
authors.lastname: Igor
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017963:Azithromycin / Q000009:adverse effects*; D001649:Bile Duct Diseases / Q000139:chemically induced*; D002779:Cholestasis / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin