CHOLESTATIC LIVER-DISEASE WITH DUCTOPENIA (VANISHING BILE-DUCT SYNDROME) AFTER ADMINISTRATION OF CLINDAMYCIN AND TRIMETHOPRIM-SULFAMETHOXAZOLE

Two patients who developed cholestatic liver disease after exposure to antibiotics are described. One patient who received clindamycin had l iver biopsy findings of marked cholestasis, portal inflammation, bile duct injury and bile duct paucity (ductopenia). A second biopsy after clinical improvement showed resolution of cholestasis but persistence of duct paucity. Three years later, treatment with ampicillin caused a nother episode of cholestatic hepatitis with cholestasis and duct pauc ity on rebiopsy. The second patient, who developed cholestasis after r eceiving trimethoprim-sulfamethoxazole, had marked duct paucity in the liver biopsy. This is the first description, to our knowledge, of duc topenia apparently caused by clindamycin. Cross-reactivity between cli ndamycin and ampicillin is also demonstrated in one patient. This repo rt documents that duct paucity may occur within 10 days of onset of ja undice and appears to be confined to ducts less than 0.03 mm in diamet er.