Acute cholestatic hepatitis associated with celecoxib.
OBJECTIVE
To report a case of acute cholestatic hepatitis associated with the selective cyclooxygenase-2 inhibitor celecoxib.


METHODS
A 41-year-old white man was hospitalized for jaundice after 2 doses of celecoxib 200 mg for pain associated with right-knee trauma. Laboratory workup showed hyperbilirubinemia, mildly elevated serum transaminase concentrations, and cholestasis. Abdominal imaging showed no dilation of the biliary tree. Histology showed cholestasis, with bile plugs in dilated bile canaliculi and a mild portal infiltrate that are highly suggestive of drug-induced cholestasis.


CONCLUSIONS
This is the fourth report in the English-language literature describing cholestatic hepatitis temporally related to celecoxib use, the second supported by histologic findings typical of drug-induced cholestasis, and the first in a patient who denied use of alcoholic beverages and was taking no other drugs or herbal products at the time of the reaction. The Naranjo probability scale indicated that celecoxib was a probable cause of acute cholestatic hepatitis in this patient.


CONCLUSIONS
Cholestatic hepatitis is a well-recognized adverse effect of several drugs. Although celecoxib is considered to have a very low potential for hepatic toxicity, well-documented reports of adverse reactions can contribute significantly to the definition of more accurate safety profiles for new drugs introduced into clinical practice.
Grieco
Antonio
A
Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Italy. agrieco@rm.unicatt.it
Miele
Luca
L
Giorgi
Andrea
A
Civello
Ignazio M
IM
Gasbarrini
Giovanni
G
D000208:Acute Disease; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D000068579:Celecoxib; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000139:chemically induced*; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000139:chemically induced; D008297:Male; D011720:Pyrazoles; D013449:Sulfonamides / Q000009:adverse effects*; D005723:gamma-Glutamyltransferase / Q000097:blood
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000068579:Celecoxib