This case study follows a 20-year old young man with ulcerative colitis and elevated AST, ALT, Alkaline Phosphatase, and IgG4, as well as narrowed bile ducts and liver inflammation and fibrosis.

While steroids lowered his liver enzymes in the him short-term, they increased when he tapered off, so he was prescribed oral vancomycin (OV) at 500 mg 3x/day. Within one month, his liver enzymes and IgG4 normalized.