title: Prolonged cholestasis and ductopenia associated with tenoxicam.
abstract: Cholestatic liver diseases leading to progressive destruction of intra-hepatic bile ducts and ductopenia encompass multiple etiologies. Pathophysiology and natural history of drug-induced cholangiopathies remain unclear. We report a case of prolonged ductopenia attributed to Tenoxicam (Tilcotil o--a non-steroidal anti-inflammatory drug of the oxicam family) ingested at therapeutic dose. A 36 year-old male patient was admitted for jaundice and Lyell syndrome starting 1 week after the ingestion of Tenoxicam. Liver biopsy showed cholestasis, non-suppurative cholangitis and polymorphous inflammatory infiltrate of the portal tracts (round cells, macrophages an eosinophils). Treatment with ursodesoxycholic acid and cholestyramine was instituted and the patient was asymptomatic 1 year after. Three years later mild biological cholestasis persisted and ductopenia was evidenced on liver biopsy. In this report we found that: (1) The toxicity of tenoxicam was probably mediated by an immunoallergic mechanism (Lyell syndrome and eosinophils on histology); (2) ductopenia was secondary to inflammatory cholangitis. Factors responsible for this chronic evolution are still unknown (genetic predisposition, vascular factors, etc.); and (3) the presence of ductopenia contrasted with the "clinical recovery" of the disease suggesting accessory bile drainage by cholangioles or partial reconstruction of the biliary tree.
authors.affiliation: Department of Pathology, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France.
authors.forename: Viviane
authors.initials: V
authors.lastname: Trak-Smayra
authors.forename: Dominique
authors.initials: D
authors.lastname: Cazals-Hatem
authors.forename: Tarik
authors.initials: T
authors.lastname: Asselah
authors.forename: Veronique
authors.initials: V
authors.lastname: Duchatelle
authors.forename: Claude
authors.initials: C
authors.lastname: Degott
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001706:Biopsy; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000139:chemically induced / Q000473:pathology; D008297:Male; D010894:Piroxicam / Q000009:adverse effects* / Q000031:analogs & derivatives*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; C032801:tenoxicam