Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy ...Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment, but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil.展开更多
The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally,and the number of cases is expected to continue to increase,at least in the...The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally,and the number of cases is expected to continue to increase,at least in the immediate future.The virus is estimated to have infected more than 1.5 million individuals.The available reports suggest that gastrointestinal(GI)involvement in coronavirus disease 2019(COVID-19)is common and in some cases the GI symptoms may precede the respiratory symptoms.In addition to direct effects of severe acute respiratory syndrome coronavirus 2,the infected patients remain at risk for the complications commonly managed by gastroenterology and hepatology consultants.The most commonly reported GI manifestation of COVID-19 is diarrhea,which is reported in a third to up to more than half of the patients.Mild to moderate elevation of the liver enzymes are also common,although no case of acute liver failure has been reported so far.Many of the medications used for treatment of COVID-19 can also be associated with GI symptoms or liver injury and can be included in the differential diagnosis in these patients.Although the diagnosis of the infection is currently based on RNA analysis in respiratory samples,the available literature on fecal shedding of this virus suggests that fecal RNA testing might prove to be a useful diagnostic test.It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while most patients can be considered high risk for having been exposed to the virus.展开更多
文摘Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment, but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil.
文摘The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally,and the number of cases is expected to continue to increase,at least in the immediate future.The virus is estimated to have infected more than 1.5 million individuals.The available reports suggest that gastrointestinal(GI)involvement in coronavirus disease 2019(COVID-19)is common and in some cases the GI symptoms may precede the respiratory symptoms.In addition to direct effects of severe acute respiratory syndrome coronavirus 2,the infected patients remain at risk for the complications commonly managed by gastroenterology and hepatology consultants.The most commonly reported GI manifestation of COVID-19 is diarrhea,which is reported in a third to up to more than half of the patients.Mild to moderate elevation of the liver enzymes are also common,although no case of acute liver failure has been reported so far.Many of the medications used for treatment of COVID-19 can also be associated with GI symptoms or liver injury and can be included in the differential diagnosis in these patients.Although the diagnosis of the infection is currently based on RNA analysis in respiratory samples,the available literature on fecal shedding of this virus suggests that fecal RNA testing might prove to be a useful diagnostic test.It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while most patients can be considered high risk for having been exposed to the virus.
