ABSTRACT
A 45-year-old male with hypertension and alcohol use disorder presented to the hospital after being found intoxicated, with bright red blood in the toilet and around his mouth. He was found to be tachycardiac and required intubation due to his inebriated state to establish a secure airway. Initial workup revealed a hemoglobin decrease from 16.7 g/dL to 8.7 g/dL, as well as lactic acidosis. He quickly underwent an upper endoscopy to evaluate his source of hematemesis. An actively bleeding lesion was found in the proximal stomach consistent with prolapse gastropathy syndrome. This case highlights a unique presentation of hematemesis that requires endoscopic evaluation for both diagnosis and treatment.
ABSTRACT
Atorvastatin is a commonly used oral cholesterol-lowering agent. Side effects associated with statin therapy include arthralgia, myalgia, dyspepsia, weakness, and headache. Prospective and retrospective studies of drug-induced liver injury have identified statin-induced hepatotoxicity, with atorvastatin being the most commonly cited. Associated liver function test elevations have varied from hepatocellular to cholestatic/mixed pattern. We report a case of a 58-year-old woman that illustrates unusual histologic findings associated with a mixed pattern of statin-induced liver injury. While being treated with atorvastatin, the patient exhibited repeated bouts of abdominal pain over a year associated with biliary tree dilation, variably attributed to postcholecystectomy dilation and stenosis of the ampulla of Vater. Following sphincterotomy, the patient's bilirubin normalized but the other liver function tests remained elevated. Liver biopsy revealed portal and lobular inflammation with cholangiolysis. The patient's liver function tests normalized following cessation of atorvastatin therapy.
