Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Fukuoka, Jonan, 814-0180, Japan.
Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Clin J Gastroenterol. 2022 Aug;15(4):784-790. doi: 10.1007/s12328-022-01650-4. Epub 2022 Jul 8.
A 75-year-old man was admitted to our hospital with acute onset of marked jaundice, elevated liver enzymes, and hyperlipidemia. He had been taking clopidogrel and pemafibrate for 3 months. He tested negative for autoantibodies and hepatitis-causing viruses. Gadoxetate-enhanced magnetic resonance imaging showed diffusely hypointense liver parenchyma in the hepatobiliary phase, with no appreciable excretion of gadoxetate into the biliary system. Histological examination of a liver specimen revealed disappearance of the bile ducts in the portal area and decreased expression of organic transporting polypeptide 1B3 on immunostaining. The patient was diagnosed with drug-induced vanishing bile duct syndrome and treated with ursodeoxycholic acid. The signs of liver dysfunction shown on blood chemistry tests improved spontaneously. After the acute hepatitis and lipid abnormalities had improved, repeat liver biopsy and gadoxetate-enhanced magnetic resonance imaging revealed improvement of the vanishing bile duct syndrome and recovery of the expression of organic transporting polypeptide 1B3. The reduction of OATP1B3 expression might be involved in the development of vanishing bile duct syndrome.
一位 75 岁男性因急性发作的显著黄疸、肝酶升高和高脂血症而入院。他已经服用氯吡格雷和 pemafibrate 3 个月。他自身抗体和肝炎病毒检测均为阴性。钆塞酸增强磁共振成像显示肝胆期肝实质弥漫性低信号，无明显钆塞酸排入胆道系统。肝组织学检查显示门区胆管消失，免疫染色显示有机转运多肽 1B3 表达减少。该患者被诊断为药物诱导的消失性胆管综合征，并接受熊去氧胆酸治疗。血液生化检查显示肝功能异常的迹象自发改善。急性肝炎和脂质异常改善后，重复肝活检和钆塞酸增强磁共振成像显示消失性胆管综合征改善，有机转运多肽 1B3 表达恢复。OATP1B3 表达减少可能与消失性胆管综合征的发生有关。
