Abstract
A 37 year old black woman is described with difficult-to-control diabetes (DM), morbid obesity, hypertension, and chronic skin abscesses. During admission for control of skin abscesses, she received trimethoprim-sulfamethoxazole (TMP-SMZ), which was continued for 30 days after discharge. She then required admission for UTI and was treated with antibiotics. Metformin and glimepiride were added at the time of discharge, as parenteral insulin was poorly controlling the DM. Shortly thereafter she developed a cholestatic drug reaction, which progressed to end-stage liver disease (ESLD) with the histologic features of vanishing bile duct syndrome (VBDS). Clinical characteristics of medication-induced cholestatic liver disease and VBDS are discussed.
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