Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC 3199, Australia.
School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Australia.
J Int Med Res. 2020 Aug;48(8):300060520937842. doi: 10.1177/0300060520937842.
Vanishing bile duct syndrome (VBDS) refers to a group of acquired disorders associated with progressive destruction and disappearance of the intrahepatic bile ducts. We report a case of meropenem-induced VBDS in a patient who had undergone surgical repair of a ruptured abdominal aortic aneurysm. Meropenem was used to treat isolated from blood, urine, sputum, and wound swab cultures. The patient developed severe mixed liver injury with no obstruction noted in radiological imaging. Because of the patient's increasing serum bilirubin level, VBDS was suspected and the meropenem was therefore changed to ciprofloxacin on postoperative day 18. Although the bilirubin level decreased, meropenem was restarted 3 days later because of clinical concerns regarding worsening fever and sepsis. Restarting meropenem was associated with an immediate increase in the serum bilirubin level. This further increase in bilirubin after reintroduction of meropenem strongly suggested meropenem-induced VBDS. The antibiotic therapy was changed from meropenem to ciprofloxacin and metronidazole, leading to a dramatic decrease in the bilirubin level to normal within a few weeks. In patients receiving meropenem, VBDS as a cause of deranged liver function and cholestasis should be considered after ruling out mechanical and other probable causes of liver injury.
胆流消失综合征（VBDS）是一组与肝内胆管进行性破坏和消失相关的获得性疾病。我们报告了一例美罗培南引起的 VBDS 病例，该患者曾接受过腹主动脉瘤破裂的手术修复。美罗培南用于治疗从血液、尿液、痰和伤口拭子培养物中分离出的感染。患者发生严重混合性肝损伤，影像学检查未见梗阻。由于患者血清胆红素水平升高，怀疑为 VBDS，并于术后第 18 天将美罗培南更换为环丙沙星。尽管胆红素水平下降，但由于临床担心发热和脓毒症加重，3 天后重新开始使用美罗培南。重新使用美罗培南后，胆红素水平立即升高。在重新使用美罗培南后胆红素的进一步增加强烈提示为美罗培南引起的 VBDS。抗生素治疗从美罗培南改为环丙沙星和甲硝唑，导致胆红素水平在数周内迅速降至正常。在接受美罗培南治疗的患者中，在排除机械和其他可能导致肝损伤的原因后，应考虑 VBDS 是肝功能和胆汁淤积紊乱的原因。
