In suspected antibiotic-associated cholestatic DILI with jaundice and no obstructing lesion on MRCP, what specific clinical or laboratory trajectory triggers you to proceed to early liver biopsy to evaluate for evolving vanishing bile duct syndrome rather than continued close outpatient monitoring?

This is an important question because early awareness and a confirmed diagnosis will result in a better outcome. 1- Needs a clear history and exclusion of other potential etiologies. 2- Need to know whether the patient has underlying liver disease, i.e., metabolic dysfunction-associated steatotic li...