Vanishing bile duct syndrome in human immunodeficiency virus: Nevirapine hepatotoxicity revisited

Figure 1 Magnetic resonance cholangiopancreatography. Patent biliary system without evidence of strictures or obstruction with normal caliber common bile duct (C), right hepatic duct (R), and left hepatic duct (L).

Figure 2 Liver biopsy showing portal tract with normal appearing hepatic vein and hepatic artery, and absence of bile ducts. A: PAS-D stain, × 200 magnification; B: Hematoxylin and eosin stain, × 200 magnification.

Figure 3 Liver biopsy specimen with cytokeratin staining for biliary elements. A: No bile ducts are seen, minimal ductular proliferation is apparent at the edges of the portal tract (long arrows); B: Solitary portal tract with presence of irregular bile ducts (long arrows) and ductular proliferation (short arrows).

Figure 4 Trend of liver enzymes and bilirubin during the patient’s clinical course.