[Trimethoprim-sulfamethoxazole-induced cholestatic hepatitis. Clinico-immunological demonstration of its allergic origin].
METHODS
A 22-year-old woman was given trimethoprim plus sulphamethoxazole for a urinary infection (160 and 800 mg, respectively, daily), drugs she had not previously taken. After 2 weeks she noticed a rash of small spots on her trunk. In addition she had nausea and vomiting. The rash faded within 2 days of stopping the drug, but progressive jaundice developed.


METHODS
SGPT and SGOT concentrations rose to maximally 328 and 83 U/l, total bilirubin to maximally 5.9 mg/dl. There was no evidence for viral hepatitis (B or C, cytomegalovirus, Epstein-Barr), autoimmune hepatitis or primary biliary hepatitis. Liver biopsy showed central acinar cholestasis, which suggested drug-induced liver damage.


RESULTS
The patient's symptoms regressed over several weeks without any specific treatment and 8 weeks after onset of the rash the laboratory tests also became normal. The allergic cause of the cholestatic hepatitis was confirmed by a lymphocyte transformation test.


CONCLUSIONS
Clinical suspicion of drug allergy as cause of a cholestatic hepatitis can be confirmed reliably and without any risk to the patient with the lymphocyte transformation test.
Cario
E
E
Abteilung für Gastroenterologie, Medizinische Klinik, Universitätsklinikum Essen.
Rünzi
M
M
Becker
E W
EW
Gröger
G
G
Ali
A
A
Rehbehn
K
K
Goebell
H
H
Layer
P
P
D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008213:Lymphocyte Activation / Q000187:drug effects; D012075:Remission, Spontaneous; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D000892:Anti-Infective Agents, Urinary; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
Trimethoprim-Sulfamethoxazol-induzierte cholestatische Hepatitis. Klinisch-immunologischer Nachweis der allergischen Genese.