A CASE OF DRUG-INDUCED DUCTOPENIA RESULTING IN FATAL BILIARY-CIRRHOSIS

A 50-year-old woman suffered from a diffuse skin rash, high fever and jaundice immediately after a second injection of glutathion and Strong er Neo-minophagen C which contains glycyrrhizin. Liver biopsy performe d 11 months after the onset showed mild spotty hepatocyte necrosis, ma rked cholestasis in parenchyma, and some lymphocyte infiltration in th e portal area. Interlobular bile ducts had undergone vacuolar degenera tion or were absent in some portal tracts. In her hospital course, unr emitting jaundice persisted and biliary cirrhosis developed with signs of portal hypertension; she died from liver failure 26 months after t he onset. A liver specimen at her death revealed that most of the inte rlobular bile ducts had vanished. Based on the clinical course and pat hology, drug-induced ductopenia, possibly due to an adverse reaction t o glycyrrhizin, is the most likely diagnosis. While drug-related bilia ry cirrhosis is rarely fatal, this case presented an unusually rapid c ourse of fatal biliary cirrhosis.