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- Title
CHOLESTATIC HEPATITIS WITH IMMUNOALLERGIC FEATURES.
- Authors
Boeriu, Giorgia; Chiriloiu, Mara; Borgovan, Sinziana; Verdes, Adrienn Diana; Boeriu, Alina
- Abstract
Background: Drug induced immunoallergic hepatitis (IA) represents an acute liver injury, induced by a recent exposure to a specific drug (sulfonamides, macrolide and fluoroquinolone antibiotics, penicillins, celecoxib, allopurinol, carbamazepine, phenytoin, phenobarbital). Rash, fever, eosinophilia or atypical lymphocytosis, facial edema, lymphadenopathy or arthralgias are important additional signs and symptoms of hypersensitivity. Objective: We present a case of the DRESS syndrome (drug rush with eosinoplilia and systemic symptoms) due to allopurinol and associated IA with prominent cholestatic features. Material and methods: A 73-year-old female patient, with a history of hypertension, type 2 insulin dependent diabetes, diabetic nephropathy, hyperuricemia, mild anemia, was admitted for fatigue, fever, edema, rash, arthralgias, and azotate retention. Fever and skin rash developed two days after starting therapy with Allopurinol, recommended by the family doctor. The first admission was in the Dermatology service, where an impairment of renal function was detected (creatinin 1.93 mg/dl, urea 117 mg/dl, Na+ 136 mmol/l, K= 5.40 mmol/l, proteinuria 324 mg/24 h, negative urine cultures). The patient was transferred to the Nephrology Department. Laboratory workup showed normochromic normocytic anemia (Hgb 9.82 g/dl, Htc 31.78%,), 16.80% eosinophilia. Liver enzymes showed cytolysis (ALT 280, AST 78 U/l) and marked cholestasis (GGT 973 U/l, Alk P 552 U/l, total bilirubin 0.56 mg/dl). Tests for viral hepatitis were negative as well as autoantibodies. No sign of biliary tract obstruction was detected on abdominal ultrasound. Results: Rehydration therapy, hepatoprotectors, ursodeoxycolic acid, antihypertensive drug, and low protein diet were recommended, with progressive improvement of patient condition. Conclusions: The rare entity of IH should be taken into consideration in patients who develop increased liver enzymes along with fever, rash, arthralgia, eosinophilia or edema. Symptoms are rapidly reversible with stopping the medication, although severe acute liver failure, generalized skin rash or renal disease followed by death after allopurinol administration, were described in the literature.
- Subjects
DIABETIC nephropathies; SYMPTOMS; LOW-protein diet; VIRAL hepatitis; PHYSICIANS; MACROLIDE antibiotics
- Publication
Acta Medica Marisiensis, 2019, Vol 65, p42
- ISSN
2068-3324
- Publication type
Article