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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Efficacy of oral vancomycin in recurrent primary sclerosing cholangitis following liver transplantation
  1. Penelope Hey1,
  2. Julie Lokan2,
  3. Paul Johnson3,
  4. Paul Gow1
  1. 1Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
  2. 2Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
  3. 3Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Penelope Hey, penelope.hey{at}austin.org.au

Summary

Primary sclerosing cholangitis (PSC) is a liver disease that leads to progressive destruction and stricturing of the biliary tree. Unfortunately, apart from orthotopic liver transplantation (OLT), there are no universally accepted therapies to treat this disease. Even following transplantation, recurrence of PSC is seen in approximately one quarter of patients and leads to high rates of graft failure. Oral vancomycin, through possible immunomodulatory and anti-inflammatory mechanisms, has been shown in small-scale studies to be successful in improving liver function tests in patients with pretransplant PSC. We report the first case of an adult patient diagnosed with recurrent PSC 4 years after OLT who was treated with oral vancomycin leading to complete normalisation of his liver biochemistry. This case adds to the growing literature of a potential therapeutic role for this antibiotic in PSC and highlights interesting questions regarding mechanisms of disease.

  • portal hypertension
  • cirrhosis
  • biliary intervention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2017-221165

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    Footnotes

    • Contributors PH reviewed the details of the case, created figures and drafted the case report. All authors contributed to the editing of the final product. JL reviewed and prepared histopathology slides and edited the article prior to submission. PG and PJ have been involved in the long-term management of this patient. They also contributed significantly to the writing and editing of this report.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.