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vanishing bile duct syndrome in human immunodeficiency virus: Nevirapine hepatotoxicity revisited

World Journal of Gastroenterology 2010年第26期16卷 3335-3338页

作者： Rajan Kochar Moises I Nevah Frank J Lukens Michael B Fallon Victor I Machicao Division of Gastroenterology Hepatology and Nutrition The University of Texas Health Science Center at Houston Houston TX 77030 United States

vanishing bile duct syndrome (VBDS) refers to a group of disorders characterized by prolonged cholestasis as a result of destruction and disappearance ofintrahepatic bile ducts. Multiple etiologies have been indentifi ed including infections, neoplastic disorders, autoimmune conditions and drugs. The natural history of this condition is variable and may involve resolution of cholestasis or progression with irreversible damage. VBDS is extremely rare in human immunodeficiency virus (HIV)-infected patients and anti-retroviral therapy has never been implicated as a cause. We encountered a young pregnant female with HIV and VBDS secondary to anti-retroviral therapy. Here, we report her clinical course and outcome.

关键词： vanishing bile duct syndrome ductopenia Acquired immune deficiency syndrome Cholangiopathy Cholestasis Drug-induced liver injury

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Naproxen-induced liver injury

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 552-556页

作者： Sharif Ali Jason D Pimentel Department of Pathology and Laboratory Medicine Henry Ford Hospital 2799 West Grand Blvd. Detroit MI 48202 USA

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to induce liver injury. Patterns of the injury usually range from mild elevations of liver enzymes to sometimes severe fulminant hepatic failure. Likewise, naproxen is a propionic acid derivative NSAID that was introduced in 1980 and has been available as an over-the- counter medication since 1994, but has rarely been reported to cause liver injury. METHODS: We treated a 30-year-old woman with jaundice and intractable pruritus that developed shortly after taking naproxen. We reviewed the medical history and liver histopathology of the patient as well as all previously published case reports of naproxen-associated liver toxicity in the English language literature. RESULTS: The liver biochemical profile of the patient revealed a mixed cholestasis and hepatitis pattern. Consecutive liver biopsies demonstrated focal lobular inflammation, hepatocyte drop-out, and a progressive loss of the small interlobular bile ducts (ductopenia). The biopsy performed two years after onset of the disease showed partial recovery of a small number of bile ducts; however, 10 years passed before the biochemical profile returned to near normal. CONCLUSIONS: Naproxen-associated liver toxicity remains a rare entity, but should be considered in any patient presenting with cholestasis shortly after its use. Liver injury is most commonly seen in a mixed pattern characterized by cholestasis and hepatitis. The resulting liver damage may take years to resolve.

关键词： naproxen ductopenia vanishing bile duct syndrome propionic acid liver injury

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