CHLORPROMAZINE-INDUCED VANISHING BILE-DUCT SYNDROME LEADING TO BILIARY-CIRRHOSIS

We describe a 33-yr-old pregnant woman in whom a primary biliary cirrh osis-like syndrome developed after 2 wk of chlorpromazine therapy. The clinical course was characterized by severe jaundice lasting 22 mo, i ntense pruritus, fever, steatorrhea, high alkaline phosphatase levels and hypercholesterolemia. Jaundice resolved with initiation of ursodeo xycholic acid therapy, but subclinical cholestasis and low-level infla mmatory activity persisted and ultimately evolved into biliary cirrhos is. The pathological substrate of this severe and prolonged cholestati c reaction was found to be the vanishing bile duct syndrome with a mar ked transient pseudoxanthomatosis.