Fatal cholestatic hepatitis caused by D-penicillamine.
A 37-yr-old woman with RF-positive RA developed cholestatic hepatitis after 10 days of D-penicillamine therapy. This was discontinued immediately. The cholestasis persisted for the remaining 14 months of her life. Severe hypercholesterolemia developed with xanthelasmata and eventually pancytopenia, which was caused by a massive infiltration of the bone marrow by lipid-containing foam cells. The patient died of sepsis. Review of the literature shows intrahepatic cholestasis to be a rare and idiosyncratic complication of D-penicillamine therapy. To our knowledge, ours is the first documented case of persistent cholestatic icterus.
Jacobs
J W
JW
Department of Rheumatology, University Hospital Utrecht, The Netherlands.
Van der Weide
F R
FR
Kruijsen
M W
MW
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D002779:Cholestasis / Q000139:chemically induced*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D010396:Penicillamine / Q000009:adverse effects*
D010396:Penicillamine