Vanishing bile duct syndrome in a HIV patient on HAART therapy

Gnanaraj, Jerome; Fiedler, Paul; Virata, Michael

doi:10.1136/bcr.06.2011.4369

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…In 3 of the 4 reported cases, potential cofounding etiologic factors existed that are also known causes of VBDS and hepatotoxicity, including concurrent medications (clindamycin, sulfadiazine, sulfamethoxazole/trimethoprim, ciprofloxacin, ibuprofen), infection (Epstein-Barr virus), and neoplastic condition (Hodgkin lymphoma). 6,9,10 In the case report by Kochar et al, nevirapine was implicated as the most likely cause of VBDS in a 28-year-old pregnant female who developed symptoms of hepatotoxicity 4 weeks after initiating zidovudine, lamivudine, and nevirapine. 8 Lamivudine and zidovudine were ruled out as potential causes since the patient did not present with signs of toxicity from these agents that are typically associated with lactic acidosis, elevated lactate dehydrogenase levels, amylase, and lipase in addition to abnormal LFTs.…”

Section: Discussionmentioning

confidence: 99%

“…Vanishing bile duct syndrome is rare in the HIV-infected population, and to date, only 6 previous cases of VBDS in HIV-infected adults have been published. 6,8 –11 Antiretroviral therapy (ART) has been implicated as causal in 4 of the cases, specifically nevirapine and atazanavir. 6,8 –10 We report the case of a male living with HIV, who developed VBDS secondary to ART.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efavirenz-Induced Vanishing Bile Duct Syndrome: A Case Report

Nwaesei

Moye-Dickerson

Dretler

2019

Journal of Pharmacy Practice

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Background: Efavirenz (Sustiva®) is used for the treatment of human immunodeficiency virus (HIV) type 1 infection. Hepatoxicity is a known potential adverse drug event with efavirenz; however, to our knowledge, vanishing bile duct syndrome (VBDS), a type of liver injury, has not been reported with this therapy. Case Presentation: We report the case of a 48-year-old male with HIV and VBDS secondary to antiretroviral therapy. The patient was started on efavirenz, emtricitabine, and tenofovir disoproxil fumarate (Atripla®). Four weeks later, the patient presented with complaints of poor appetite, nausea with emesis, dark urine, and malaise. Labs obtained supported the diagnosis of acute hepatitis, and a liver biopsy confirmed a diagnosis of VBDS. The Naranjo adverse drug reaction probability scale showed that it was probable (score of 7) that the VBDS was related to drug therapy. Efavirenz was assessed to be the most likely cause of VBDS, end-stage liver disease, and the eventual need for liver transplantation. Conclusion: To our knowledge, this is the first reported case of probable efavirenz-induced VBDS in a patient living with HIV. Recognition and awareness of this adverse drug reaction by clinicians for quick diagnosis, discontinuation of therapy, and management are important in patients receiving this regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efavirenz-Induced Vanishing Bile Duct Syndrome: A Case Report

Nwaesei

Moye-Dickerson

Dretler

2019

Journal of Pharmacy Practice

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“…It has been documented in cases of Hodgkin's lymphoma5 and has been reported to be related to several infective causes including CMV,6 EBV7and HIV in the context of highly active antiretroviral therapy 8. Drugs implicated as precipitating this condition include the antiseizure medications valproic acid,9 carbamazepine10 and lamotrigene 11.…”

Section: Discussionmentioning

confidence: 99%

Vanishing bile duct syndrome in the context of concurrent temozolomide for glioblastoma

Mason¹,

Adeyi

Fung

et al. 2014

BMJ Case Reports

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Temozolomide, an oral alkylating agent, is used in the treatment of glioblastoma. We describe a case of a 62-year-old woman developing jaundice with significant derangement of liver function tests on day 17 of focal radiotherapy with concomitant temozolomide. There was no structural abnormality on imaging and liver biopsy was performed. Pathology revealed absence of small terminal bile ducts affecting up to 60% of sampled portal tracts and senescence of many of the remaining small bile ducts, in keeping with a diagnosis of acute vanishing bile duct syndrome. This is a rare syndrome. It has been documented in association with Hodgkin's lymphoma and viral causes. Drugs implicated as precipitating this condition include antiseizure medications, some antibiotics, ibuprofen and antifungals. Temozolomide was stopped. The patient received supportive care, ursodeoxycholic acid 750 mg daily and cholestyramine 4 g twice daily. She was otherwise asymptomatic and her blood results returned to normal by day 129.

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