{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:32:35Z","timestamp":1791822755797,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,7,14]],"date-time":"2022-07-14T00:00:00Z","timestamp":1657756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:p>Ductopenia is often regarded as a chronic process where \u226550% of portal tracts lack bile ducts, which is also known as vanishing bile duct syndrome (VBDS). One aetiology is drug\u2010induced liver injury. Cloxacillin, an antistaphylococcal penicillin, typically causes \u201cbland\u201d cholestasis. We present the first case of cloxacillin\u2010induced acute ductopenia or VBDS and a review of published cloxacillin\u2010induced liver injuries. A 66\u2010year\u2010old woman with no prior liver disease, but known penicillin allergy, was treated for postcarotid angioplasty staphylococcal infection with 6\u00a0weeks of cloxacillin. She presented with a 2\u2010week history of weakness and jaundice. Laboratory work\u2010up showed elevated liver enzymes with a cholestatic pattern, hyperbilirubinemia and eosinophilia. She required ICU transfer for hypotension and was started empirically on prednisone. Liver biopsy revealed severe centrilobular cholestasis, mild necroinflammation and ductopenia with epithelial injury, but no ductular reaction. Two months later she was discharged on hydrocortisone and ursodiol with persistently elevated alkaline phosphatase and bilirubin. She was considered for liver transplantation but died of liver failure 4\u00a0months later. Four additional articles were found with histopathologic descriptions of cloxacillin\u2010related liver injury. These included portal inflammation, cholestasis and mild necroinflammation. Clinical features were reported in two cases; both had mild symptoms with cholestatic liver enzymes and hyperbilirubinemia. Both patients recovered completely within 10\u201060\u2009days. Cloxacillin\u2010induced cholestasis can be secondary to acute ductopenia, which can result in worse clinical outcomes than previously described \u201cbland\u201d cholestasis. Liver biopsy is recommended to identify cases with acute VBDS.<\/jats:p>","DOI":"10.1111\/bcp.15445","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T06:43:11Z","timestamp":1655880191000},"page":"4633-4638","source":"Crossref","is-referenced-by-count":10,"title":["Cloxacillin\u2010induced acute vanishing bile duct syndrome: A case study and literature review"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7888-676X","authenticated-orcid":false,"given":"Kyrillos","family":"Faragalla","sequence":"first","affiliation":[{"name":"Internal Medicine University of Saskatchewan  Saskatoon SK Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Lau","sequence":"additional","affiliation":[{"name":"Gastroenterology Halton Healthcare  Oakville ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanlin L.","family":"Wang","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Medicine, David Geffen School of Medicine University of California Los Angeles  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimin","family":"Liu","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Halton Healthcare  Oakville ON Canada"},{"name":"Pathology and Molecular Medicine, Faculty of Health Sciences McMaster University  Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.4065\/73.3.285"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22742"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2007.11.007"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168\u20108278(88)80482\u20103"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000444443"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v8.i24.6524"},{"key":"e_1_2_8_8_1","volume-title":"MacSween's Pathology of the Liver","author":"Burt A","year":"2018"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100029\u20101240005"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24229"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840200610"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168\u20108278(97)82330\u20106"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168\u20108278(05)80476\u20103"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.30.9.953"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3182a95951"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.5223\/pghn.2013.16.4.273"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100676.1993.tb00635.x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.14309\/crj.0000000000000349"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr\u20102019\u2010233052"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.4.5733.455"},{"issue":"1","key":"e_1_2_8_21_1","first-page":"81","article-title":"Flucloxacillin associated cholestatic hepatitis. An Australian and Swedish epidemic?","volume":"49","author":"Devereaux BM","year":"1995","journal-title":"Eur J Clin Pharmacol"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tox.2008.08.009"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.3109\/00313029309066576"},{"key":"e_1_2_8_24_1","first-page":"270","article-title":"Jaundice and an itch following a fall","volume":"31","author":"Nghona N","year":"2013","journal-title":"Contin Med Educ"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1965.03080080064024"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.280.6219.982"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.74.867.59"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms17010014"},{"issue":"5","key":"e_1_2_8_29_1","first-page":"569","article-title":"Long\u2010term sequelae of acetaminophen\u2010associated fulminant hepatic failure: relevance of early histology","volume":"83","author":"Baeg NJ","year":"1988","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2007.01118.x"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025\u20106196(11)63706\u20103"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2015.03.002"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840090209"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2009.03.003"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168\u20108278(92)90029\u2010O"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840150212"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28967"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.1677"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100041\u20101729972"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.820724"},{"issue":"11","key":"e_1_2_8_41_1","first-page":"1232","article-title":"Drug and toxin\u2010induced bile duct disorders","volume":"15","author":"Geubel AP","year":"2000","journal-title":"J Gastroenterol Hepatol"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1012351231143"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742\u20107843.2009.00474.x"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101754.2008.01291.x"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.14.4697"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.45.6087"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14503"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013\u20102239"},{"key":"e_1_2_8_49_1","first-page":"S1","article-title":"The concise guide to pharmacology 2019\/2020","volume":"176","author":"Alexander SPH","journal-title":"Br J Pharmacol"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bcp.15445","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bcp.15445","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bcp.15445","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T16:47:23Z","timestamp":1692809243000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1111\/bcp.15445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,14]]},"references-count":48,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1111\/bcp.15445"],"URL":"https:\/\/doi.org\/10.1111\/bcp.15445","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"value":"0306-5251","type":"print"},{"value":"1365-2125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,14]]}}}