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Vanishing bile duct syndrome in a child with toxic epidermal necrolysis: An interplay of unbalanced immune regulatory mechanisms

Wikrom Karnsakul, Thaschawee Arkachaisri, Kanit Atisook, Wanee Wisuthsarewong, Yudhtana Sattawatthamrong, Prapun Aanpreung

Abstract

Vanishing bile duct syndrome (VBDS) is a rare disorder and requires a liver biopsy for a diagnosis. The condition has not been reported in children with toxic epidermal necrolysis (TEN). The etiology of VBDS in our patient with TEN is most likely from drug hypersensitivity. A high index of suspicion will prompt clinicians to start more specific investigations and treatments. The use of immunosuppressive agents, intravenous immunoglobulin and ursodeoxycholic acid has not been consistently successful in these patients. A new approach with biologic agents such as anti-tumor necrosis factor-α may be a promising therapy and reduce severe adverse outcomes.

Key words. Cholestasis, ductopenia, Drug rash, trimethoprim- sulfamethoxazole

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The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for the Study of the Liver and the Canadian Association for the Study of the Liver

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