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Vanishing bile duct syndrome (VBDS) is a rare acquired disorder associated with progressive destruction and disappearance of intrahepatic bile ducts which eventually leads to cholestasis. VBDS has been linked to a variety of etiologies, including autoimmune disorders, infectious diseases, primary neoplasms, genetic abnormalities, and many classes of medications, including antibiotics, nonsteroidal anti-inflammatories (NSAIDs), anticonvulsants, antipsychotics and others. We present the case of VBDS associated with anabolic androgenic steroid (AAS) exposure in an otherwise healthy 29-year-old male. Résumé Le syndrome de disparition des canaux biliaires (SDCB) est une affection acquise rare caractérisée par la destruction progressive et la disparition des canaux biliaires intrahépatiques entrainant une cholestase. Le SDCB a été associé à diverses étiologies, dont des affections autoimmunes, des maladies infectieuses, des néoplasmes primaires, des anomalies génétiques et de nombreuses classes de médicaments, incluant des antibiotiques, des anti-inflammatoires non stéroïdiens, des anticonvulsivants, des antipsychotiques et autres. Nous présentons un cas de SDCB associé à la prise d’un stéroïde androgénique anabolisant chez un homme de 29 ans par ailleurs en bonne santé. Hepatic Ductopenia and Vanishing Bile Duct Syndrome following Anabolic Androgenic Steroid Use: A Case Report and Literature Review By Adam Mazzetti MD, Resheed Alkhiari MBBS FRCPC, Vidhya Nair MBBS MD FRCPC, Ted Xenodemetropoulos MD FRCPC About the Authors Adam Mazzetti is a PGY4 fellow in the General Internal Medicine program at McMaster University. Resheed Alkhiari is a PGY5 fellow in Gastroenterology at McMaster University. Vidhya Nair is an associate professor in Division of Anatomical Pathology at McMaster University. Ted Xenodemetropoulos is an associate professor in the Division of Gastroenterology at McMaster University. Corresponding author: adam.mazzetti@medportal.ca. Submitted: December 20, 2016. Accepted September 5, 2017. Published December 29, 2017. Introduction Vanishing bile duct syndrome (VBDS) is a rare disorder that results in progressive intrahepatic bile duct destruction and hepatic ductopenia which leads to the development of cholestasis.1,2 Drug-induced cholestasis almost always resolves after discontinuation of the offending medication but can persist and lead to the development of VBDS. Numerous drugs have been reported in association with VBDS, including antibiotics, NSAIDs, anticonvulsants, antipsychotics and others.3 In the following case report, we present a case of VBDS with hepatic ductopenia following anabolic androgenic steroid (AAS) exposure. Case A 29-year-old male presented to a local urgent care centre with a six-day history of progressive jaundice, pruritus, mild abdominal bloating and nausea. He denied any changes in bowel habits C a n a d i a n J o u r n a l o f G e n e r a l I n t e r n a l M e d i c i n e 32 V o l u m e 1 2 , I s s u e 4 , 2 0 1 7 C a s e R e p o r t

Hepatic Ductopenia and Vanishing Bile Duct Syndrome Following Anabolic Androgenic Steroid Use: A Case Report and Literature Review.