Vanishing bile duct syndrome induced by Psoraleae Fructus: A case report and literature review.

RATIONALE: Certain drugs can trigger inflammatory responses and necrosis in the interlobular bile duct epithelial cells of the liver. Persistent damage may cause bile duct disappearance and biliary cirrhosis. When over 50% of bile ducts are lost, drug-induced vanishing bile duct syndrome (VBDS), a rare yet severe clinical condition, can be diagnosed.

PATIENT CONCERNS: A 67-year-old woman had a radius fracture and took Chinese herbal medicine containing Psoraleae Fructus (PF) for 1 week, then developed jaundice and pruritus.

DIAGNOSES: Laboratory tests confirmed cholestatic liver injury, imaging studies ruled out biliary obstruction, and liver biopsy showed progressive disappearance of interlobular bile ducts, consistent with a VBDS diagnosis.

INTERVENTIONS: The patient received plasma exchange and hepatoprotective therapy.

OUTCOMES: After treatment, her liver function gradually improved.

LESSONS: PF may induce VBDS via immune or toxic mechanisms.

CONCLUSION

Clinicians should maintain a high level of suspicion for PF-associated liver injury and enhance monitoring and risk assessment during its clinical use.