Successful Long-Term Vancomycin Therapy in an Adult With Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) is a chronic autoimmune liver disease characterized by progressive inflammation, fibrosis, and multifocal strictures of intrahepatic and extrahepatic bile ducts.PSC often accompanies inflammatory bowel disease and may progress to cirrhosis and the need for liver transplantation.Medical management is not consistently successful, and despite numerous reports of vancomycin therapy for PSC, no broad consensus for it, particularly in adults, has emerged.We present the case of an adult female PSC patient with sustained symptomatic and biochemical improvement while receiving oral vancomycin for more than a decade, during which a full-term pregnancy and elective cesarean delivery occurred.Emerging evidence suggests that immunomodulatory and microbiome-mediated effects of oral vancomycin contribute to sustained biochemical remission and disease stabilization in selected PSC patients.Unique in the duration of vancomycin treatment response with a successful pregnancy during therapy, this case adds to a growing body of evidence supporting oral vancomycin treatment for PSC patients.