Aripiprazole-induced Hepatitis: A Case Report

Aripiprazole is an atypical antipsychotic that acts as a partial agonist of dopamine type 2 receptors as well as 5-HT1A receptors. It is used in the treatment of schizophrenia and in type 1 bipolar disorder for mania. Because aripiprazole is well tolerated with few side effects it is used off-label in other psychotic disorders. The prevalence of abnormal liver function tests with antipsychotic use is 32%, with clinically significant effects in 4% of cases. No cases of aripiprazole-induced liver injury have been published. We report a 28-year-old female who presented with non-affective first-episode psychosis and who was treated with aripiprazole. Initially she was medicated with 10 mg per day, with an increase to 20 mg per day on the 12th day of hospitalization. Nine days after she became icteric, with nausea and had a vomiting episode. Laboratory analysis revealed a very high level of alanine aminotransferase, and minor to moderately high levels of aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and bilirubin. Aripiprazole was tapered and paliperidone was started with the improvement of clinical and laboratory findings.

Ocorrência de Cryptococcus neoformans em fezes de pombos na cidade de Caratinga, MG - Brasil / Occurrence of Cryptococcus neoformans in pigeon droppings in the city of Caratinga, MG - Brazil

Cryptococcus neoformans é uma levedura encapsulada de grande importância médica, por ser o agente etiológico da criptococose. É encontrada em fontes ambientais, incluindo fezes de pombos, constitituindo-se em importante causa de morbidade e mortalidade em indivíduos imunodeprimidos em todo o mundo. Contudo, ainda não há estudos sobre sua ecologia na cidade de Caratinga. Para pesquisar fontes saprofíticas de C. neoformans, foram coletadas 30 amostras de excretas de pombos em 10 diferentes locais. A levedura foi isolada em todos os locais pesquisados em 27 (90%) amostras, confirmando sua ocorrência em fontes ambientais na cidade de Caratinga, MG.

Cryptococcus neoformans is encapsulated yeast of great medical importance once it is the etiologic agent of cryptococcosis. It is found in environmental sources, including pigeon droppings, being an important cause of morbidity and mortality in immunocompromised individuals worldwide. However, there are no studies on its ecology in the city of Caratinga. In order to search saprophytic sources of C. neoformans, a total of 30 samples of pigeon droppings in 10 different locations were collected. The yeast was isolated in 27(90%) samples in the areas were the research was carried out in, confirming their occurrence in environmental sources in the city of Caratinga, MG.