title: Prolonged cholestasis and ductopenia following gold salt therapy.
abstract: Hepatotoxicity, predominantly cholestatic, is a rare adverse effect of gold salt therapy, which usually completely resolves within a few months. We report the case of a female patient treated for rheumatoid arthritis, who had gold salt overdose, and in whom acute cholestatic hepatitis occurred three weeks after beginning of therapy. Evolution of gold concentration was followed in plasma and urine, as well as in cutaneous and liver dry tissue. Liver biopsy showed marked inflammatory changes of interlobular bile ducts that evolved towards ductopenia, which was responsible for prolonged cholestasis still present 15 months later. In addition, sialadenitis with sicca syndrome was noted six months after onset of the disease. The mechanism of hepatotoxicity was probably immunoallergic since liver lesions were associated with hypersensitivity syndrome including dermatitis and blood and tissue eosinophilia. This is the first report of gold salt hepatotoxicity with histological demonstration of cholangitis followed by ductopenia.
authors.affiliation: Département de Pathologie, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Basset
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Vadrot
authors.forename: Jacques
authors.initials: J
authors.lastname: Denis
authors.forename: Joël
authors.initials: J
authors.lastname: Poupon
authors.forename: Elie Serge
authors.initials: ES
authors.lastname: Zafrani
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001649:Bile Duct Diseases / Q000139:chemically induced*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002761:Cholangitis / Q000139:chemically induced; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced*; D004112:Dimercaprol / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D050607:Organogold Compounds; D009942:Organometallic Compounds / Q000009:adverse effects; D020005:Propanols; D013438:Sulfhydryl Compounds
chemical_list: D018501:Antirheumatic Agents; D050607:Organogold Compounds; D009942:Organometallic Compounds; D020005:Propanols; D013438:Sulfhydryl Compounds; D004112:Dimercaprol; C013394:aurotioprol