Supplementary Material for: Coexisting Primary Sclerosing Cholangitis and Autoimmune Hepatitis: Overlapping Challenges in Diagnosis and Treatment

Introduction:
Hepatobiliary overlap syndromes describe the coinciding presentation of more than one immune-mediated biliary and liver disease in a single patient, and present complex challenges in diagnosis and treatment. We report a case of ulcerative colitis with primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome responsive to vancomycin.

Case Presentation:
The patient is a 30-year-old female with known ulcerative pancolitis and autoimmune hepatitis. She presented to the emergency department with a constellation of gastrointestinal symptoms, including diffuse lower abdominal pain, bloody diarrhea, and nausea with bilious vomiting. Subsequent imaging revealed the additional diagnosis of primary sclerosing cholangitis, and she was diagnosed with overlap syndrome. Multiple treatment regimens were trialed with minimal improvement. She eventually achieved normalization of both clinical status and biochemical markers after the addition of vancomycin.

Conclusion:
Vancomycin is an underutilized therapy; its potential role in primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome has not been previously reported.

引言：肝胆重叠综合征（Hepatobiliary overlap syndromes）指单一名患者同时合并多种免疫介导性胆道与肝脏疾病，其诊断与治疗均面临复杂挑战。本文报告1例对万古霉素（vancomycin）应答良好的溃疡性结肠炎（ulcerative colitis）合并原发性硬化性胆管炎（primary sclerosing cholangitis）与自身免疫性肝炎（autoimmune hepatitis）重叠综合征病例。
病例报告：患者为30岁女性，既往确诊溃疡性全结肠炎（ulcerative pancolitis）与自身免疫性肝炎。因一系列胃肠道症状就诊于急诊科，症状包括弥漫性下腹痛、血性腹泻、伴胆汁性呕吐的恶心。后续影像学检查发现原发性硬化性胆管炎，遂确诊为重叠综合征。曾尝试多种治疗方案，但改善效果甚微。加用万古霉素后，患者临床状态与生化标志物（biochemical markers）均恢复正常。
结论：万古霉素是一种尚未得到充分利用的治疗手段；其在原发性硬化性胆管炎合并自身免疫性肝炎重叠综合征中的潜在应用价值此前未见报道。