Severe Azithromycin-Induced Liver Injury With Vanishing Bile Duct Syndrome Necessitating Liver Transplantation

Abstract

Drug-induced liver injury is a common cause of liver damage, with antimicrobial use as the leading cause. Although most patients recover after discontinuing the offending agent, severe cases may result in progressive disease or death, requiring liver transplantation. Azithromycin is a rare cause of idiosyncratic drug-induced liver injury, usually resolving within 4 to 8 weeks of discontinuation. Vanishing bile duct syndrome may occur in severe cases, marked by progressive ductopenia and cholestasis. We describe a rare case of azithromycin-induced liver injury with acute vanishing bile duct syndrome necessitating liver transplantation.