Vanishing bile duct syndrome following treatment of ocular toxoplasmosis with pyrimethamine and TMP-SMX

Vanishing Bile Duct Syndrome (VBDS) refers to the group of acquired disorders associated with progressive destruction and disappearance of the intrahepatic bile ducts and, ultimately, cholestasis. This is a final common pathologic pathway, resulting from multiple etiologies including autoimmune disorders, medications, genetic abnormalities, infectious diseases, and neoplastic disorders.1 Various drugs or toxins have been implicated in the development of a particular form of liver damage predominantly involving the bile ducts. Such liver toxicity is often associated with a clinical picture of prolonged cholestasis and may even evolve in rare instances, into the full picture of the vanishing bile duct syndrome, eventually complicated with biliary cirrhosis.2