title: [Trimethoprim-sulfamethoxazole-induced cholestatic hepatitis. Clinico-immunological demonstration of its allergic origin].
abstract: 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.
authors.affiliation: Abteilung für Gastroenterologie, Medizinische Klinik, Universitätsklinikum Essen.
authors.forename: E
authors.initials: E
authors.lastname: Cario
authors.forename: M
authors.initials: M
authors.lastname: Rünzi
authors.forename: E W
authors.initials: EW
authors.lastname: Becker
authors.forename: G
authors.initials: G
authors.lastname: Gröger
authors.forename: A
authors.initials: A
authors.lastname: Ali
authors.forename: K
authors.initials: K
authors.lastname: Rehbehn
authors.forename: H
authors.initials: H
authors.lastname: Goebell
authors.forename: P
authors.initials: P
authors.lastname: Layer
mesh_terms: 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*
chemical_list: D000892:Anti-Infective Agents, Urinary; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
vernacular_title: Trimethoprim-Sulfamethoxazol-induzierte cholestatische Hepatitis. Klinisch-immunologischer Nachweis der allergischen Genese.