Pediatr Gastroenterol Hepatol Nutr.  2016 Sep;19(3):210-213. 10.5223/pghn.2016.19.3.210.

Oral Vancomycin Therapy in a Child with Primary Sclerosing Cholangitis and Severe Ulcerative Colitis

• Buness C
• Lindor KD
• Miloh T

• KMID: 2364781
• DOI: http://doi.org/10.5223/pghn.2016.19.3.210

Abstract

Primary sclerosing cholangitis (PSC), a rare progressive liver disease characterized by cholestasis and bile duct fibrosis, has no accepted, effective therapy known to delay or arrest its progression. We report a 15 year old female patient diagnosed with PSC and moderate chronic active ulcerative colitis (UC) who achieved normalization of her liver enzymes and bile ducts, and resolution of her UC symptoms with colonic mucosal healing, after treatment with a single drug therapy of the antibiotic oral vancomycin. We postulate that the oral vancomycin may be acting both as an antibiotic by altering the intestinal microbiome and as an immunomodulator. Oral vancomycin may be a promising treatment for PSC that needs to be further studied in randomized trials.

Keyword

Primary sclerosing cholangitis; Ulcerative colitis; Vancomycin; Liver diseases

MeSH Terms

Bile Ducts
Child*
Cholangitis, Sclerosing*
Cholestasis
Colitis, Ulcerative*
Colon
Drug Therapy
Female
Fibrosis
Gastrointestinal Microbiome
Humans
Liver
Liver Diseases
Ulcer*
Vancomycin*
Vancomycin

Figure

• 

  Fig. 1 Case study data. ALT: alanine aminotransferase, ALP: alkaline phosphatase, AST: aspartate aminotransferase, GGT: gamma glutamyltranspeptidase.

• 

  Fig. 2 Bile duct is surrounded by concentric layers of fibrosis (H&E, ×400).

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