Division of Clinical Pharmacology, Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia.
Basic Clin Pharmacol Toxicol. 2010 Jan;106(1):62-5. doi: 10.1111/j.1742-7843.2009.00474.x. Epub 2009 Nov 9.
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.
进行性肝内胆汁淤积综合征是一种严重的胆汁淤积性疾病，与药物的毒性作用有关。史蒂文斯-约翰逊综合征是一种过敏反应性疾病，也可能由药物引起。我们报告了一例 62 岁男性患者，他在史蒂文斯-约翰逊综合征发作一个月后出现进行性肝内胆汁淤积综合征。这些药物不良反应与使用阿奇霉素（每天 500 毫克，连续 3 天）有关。该患者最初因史蒂文斯-约翰逊综合征接受了类固醇、抗组胺药和质子泵抑制剂治疗，并完全康复。然而，在史蒂文斯-约翰逊综合征发作一个月后，他出现了进行性肝内胆汁淤积综合征，并接受了类固醇、熊去氧胆酸、抗组胺药和他克莫司治疗。不幸的是，治疗无效，他被列入肝移植名单，黄疸发作 7 个月后进行了肝移植。这是首例与阿奇霉素使用相关的进行性肝内胆汁淤积综合征病例，也是少数报告进行性肝内胆汁淤积综合征和史蒂文斯-约翰逊综合征同时发生的病例之一。
