Persistent Cholestatic Hepatitis After Choledocholithiasis Removal: A Rare Case of Vanishing Bile Duct Syndrome

A 77-year-old woman presented with cholestatic hepatitis, initially diagnosed with choledocholithiasis and treated via ERCP; however, her persistent transaminase levels did not improve. A subsequent liver biopsy revealed ductopenia, consistent with vanishing bile duct syndrome (VBDS). She had been on long-term amoxicillin for maintenance therapy related to recurrent infections from sacral decubitus ulcers. Amoxicillin was determined to be the most likely offending agent behind VBDS and was discontinued. After the withdrawal of the culprit medication, the case was monitored for nearly three years, and the patient’s transaminase levels consistently trended downward with ursodeoxycholic acid before she ultimately passed away from complications arising from other comorbidities.