FLUCLOXACILLIN INDUCED LIVER-DISEASE - HISTOPATHOLOGICAL FINDINGS AT BIOPSY AND AUTOPSY

The histological appearances of liver biopsies of 13 patients who deve loped cholestasis following courses of flucloxacillin are presented. I n most of the cases jaundice and pruritus were protracted and in nearl y all cases liver function tests are yet to return to normal after mea n follow-up of 18 mths. One patient died after 7 mths of jaundice and another shows clinical evidence of secondary biliary cirrhosis. Biopsi es typically showed hepatocellular and canalicular bile stasis with mi nimal or no hepatitis. Mild portal fibrosis and a patchy portal lympho cytic infiltrate were usually present. In 4 cases bile ducts were redu ced in number and in 6 cases reduced in size. Bile duct epithelium sho wed degenerative changes but only occasional infiltration by inflammat ory cells. Ductular proliferation was quite variable and in some cases - most noticeably the fatal case - was inconspicuous despite depletio n of bile ducts. The appearances suggested damage not only of hepatocy tes but also of bile ducts and proliferating ductules. This may explai n the prolonged and occasionally irreversible hepatic disease associat ed with the use of flucloxacillin. Flucloxacillin should be included a mongst the causes of vanishing bile duct syndrome.