ABSTRACT
Ticlopidine inhibits platelet aggregation and provides beneficial secondary prevention of cerebrovascular and coronary artery disease. Frequently reported adverse effects of ticlopidine include diarrhea, nausea, and rash. However, to our knowledge, there are only a few published reports of the simultaneous occurrence of cholestatic hepatitis and pure red cell aplasia. Here we report a patient with simultaneous severe cholestatic hepatitis and pure red cell aplasia associated with ticlopidine. Although these adverse effects are rare, periodic hematological and liver function tests are recommended after starting ticlopidine.
Subject(s)
Female , Humans , Middle Aged , Acute Disease , Cholestasis/chemically induced , Chemical and Drug Induced Liver Injury/diagnosis , Liver Function Tests , Platelet Aggregation Inhibitors/adverse effects , Red-Cell Aplasia, Pure/chemically induced , Ticlopidine/adverse effectsABSTRACT
No abstract available.
Subject(s)
Aged , Humans , Male , Amiodarone/adverse effects , Anti-Arrhythmia Agents/adverse effects , Hepatitis, Alcoholic/diagnosis , Chemical and Drug Induced Liver Injury, Chronic/diagnosisABSTRACT
Theophylline has been widely used in the treatment of asthma and chronic obstructive lung disease. To date, there have been very few reports on hepatotoxicity due to theophylline. We diagnosed, through biochemical testing and a liver biopsy, a case of acute cholestatic hepatitis developed after oral consumption of theophylline. A 43 year-old man was admitted to the department of internal medicine due to jaundice and pruritus which developed after ten days administration of oral theophylline (Etheophyl ). Liver function tests showed elevated serum bilirubin at 13.2 mg/dL with AST and ALT of 71 U/L and 194 U/L. Alkaline phosphatase and gamma-GTP were also elevated at 175 U/L and 301 U/L. There was no evidence of viral or autoimmune hepatitis in laboratory tests. The patient's symptoms and liver function tests were improved after conservative treatment. After 9 months oral theophylline was readministered for the control of relapsed asthma. Then, jaundice and pruritus again developed again. A liver biopsy showed a few lymphocytes and eosinophilic inflammatory cell infiltration in portal tract and cholestasis in the lobule. Drug-induced hepatitis was diagnosed with a typical clinical course; the exclusion of all possible causes of acute hepatic dysfunction; and a positive response to accidental readministration of drug. We report this case with a review of the literature.
Subject(s)
Adult , Humans , Alkaline Phosphatase , Asthma , Bilirubin , Biopsy , Cholestasis , Chemical and Drug Induced Liver Injury , Eosinophils , Hepatitis , Hepatitis, Autoimmune , Internal Medicine , Jaundice , Liver , Liver Function Tests , Lymphocytes , Pruritus , Pulmonary Disease, Chronic Obstructive , TheophyllineABSTRACT
Ketoconazole, an imidazole derivative, is a broad spectrum antifungal agent which has been used widely in the treatment of systemic or local fungal infections. Mild asymptomatic elevation of plasma transaminase activities occurs in approximately 6% to 17.5% of patients who have used ketoconazole. However, the incidence of symptomatic hepatic injury is low and overt hepatitis develops in about 5% of the patients. Nausea and vomiting are the most frequent side reactions. Histopathological features of the reported ketoconazole induced hepatotoxicity are massive or submassive hepatocellular necrosis involving the acinar zone 3, destroyed lobular architecture with bridging necrosis and inflammatory cell infiltration on portal tracts. However, hepatic septal fibrosis with liver cirrhosis has not been reported yet. We experienced a case of hepatic septal fibrosis that developed after 9 months of ketoconazole administration.