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Drug Induced Hepatitis Progressing to Cirrhosis

Drug Induced Hepatitis Progressing to Cirrhosis. Case Presentation. 58 y/o retired business man, with PMH of CAD s/p CABG and ventricular aneurysm repair 14 years ago, was referred b/c of abnormal liver enzymes and jaundice

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Drug Induced Hepatitis Progressing to Cirrhosis

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  1. Drug Induced Hepatitis Progressing to Cirrhosis

  2. Case Presentation • 58 y/o retired business man, with PMH of CAD s/p CABG and ventricular aneurysm repair 14 years ago, was referred b/c of abnormal liver enzymes and jaundice • 10/2002 Constitutional symptoms and abnormal ALT and AST. (-) serologies for viral hepatitis, (-) ANA and unremarkabble US. • Medicine withheld a few days • 11/2002 Worsening of liver enzymes. Elevation of serum bilirubin • 12/2002 Initial visit at University of Miami

  3. Medications: Atorvastatin, Metoprolol Aspirin Ramipril > 4 years since 06/2002 (6 months) Physical exam: (+) icteric sclera Enlarged liver with smooth border, no ascites, no splenomegaly No peripheral edema, no palmar erythema, no telangectasia No encephalopathy

  4. Medications • Atorvastatin • Metoprolol • Aspirin • Ramipril • Physical Exam • (+) icteric sclera • Enlarged liver with smooth border, no ascites, • no splenomegaly • No peripheral edema, no palmarerythema, no telangectasia • No encephalopathy > 4 years since 06/2002 (6 months)

  5. Liver Biopsy Centrilobular necrosis, marked mixed cellular infiltration (including polymorphonuclear cells) and “Councilman” bodies

  6. Baseline 5 months 6 months 7 months 8 months Albumin (g/dL) (serum) 4.1 3.6 3.4 2.0 SGOT/SGPT 20/16 281/501 848/1684 1589/907 2570/1484 Total bilirubin (mg/dl) 0.6 1.6 19.9 23.2 PT (INR) 1.1 1.1 1.6 Ramipril (re)started ER visit Meds d/c Ramipril stopped Ramipril UDCA

  7. Baseline 5 months 6 months 7 months 8 months 9 months Albumin (g/dL) (serum) 4.1 3.6 3.4 2.0 2.0 SGOT/SGPT 20/16 281/501 848/1684 1589/907 2570/1484 462/310 Total bilirubin (mg/dl) 0.6 1.6 19.9 23.2 7.7 PT (INR) 1.1 1.1 1.6 1.4 Ramipril (re)started ER visit Meds d/c Ramipril stopped Ramipril UDCA OLTx

  8. Explant

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