title: Intrahepatic cholestatic jaundice related to administration of ranitidine. A case report with histologic and ultramicroscopic study.
abstract: Ranitidine may cause liver injuries ranging from transient, subclinical serum transaminases increase every 100-1,000 treated patients to cholestatic hepatitis in less than 1/100,000. Other H2-receptor antagonists are more dangerous: 11 toxic hepatitis cases have been reported as adverse effect after 1 year of marketed ebrotidine. A 75-year-old male with ischemic cardiopathy history was started on an 8 days treatment of oral ranitidine due to pirosis, without any other changes of therapy; 48 h after drug withdrawal, light-coloured stools, dark urine and icteric scleras developed. On hospital admission, 10 days later, physical examination showed slight hepatomegaly and severe jaundice with skin excoriations followed by serum mixed bilirubin further increase and aminotransferases activities mild rise. Total bilirubin peaked at 381.33 mmol/l (5.1-17.1) and progressively returned to normal, after discharge home, in 3 months and now, 1 year later, there is no sign of liver disease. Ultrasonographic biliary anomalies and the most frequent causes of liver damage were excluded. Liver biopsy confirmed ranitidine as the most likely cause of liver toxicity since histological and ultramicroscopical study revealed a drug-induced picture. We report a rare case of intrahepatic cholestasis jaundice related to ranitidine, a widely used drug. Diagnosis would need an ethically unacceptable rechallange test.
authors.affiliation: Unit of Hepatology D.H., Department of Internal Medicine Ospedale degli Incurabili, ASL NA 1, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Varriale
authors.forename: A
authors.initials: A
authors.lastname: Salvio
authors.forename: F
authors.initials: F
authors.lastname: Giannattasio
authors.forename: T
authors.initials: T
authors.lastname: d'Errico
authors.forename: L
authors.initials: L
authors.lastname: Montone
authors.forename: F
authors.initials: F
authors.lastname: Borgia
authors.forename: I
authors.initials: I
authors.lastname: Gentile
authors.forename: L
authors.initials: L
authors.lastname: Reynaud
authors.forename: G
authors.initials: G
authors.lastname: Borgia
authors.forename: R
authors.initials: R
authors.lastname: Rossiello
authors.forename: M
authors.initials: M
authors.lastname: Visconti
mesh_terms: D000368:Aged; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000473:pathology; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D041781:Jaundice, Obstructive / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D011899:Ranitidine / Q000009:adverse effects*
chemical_list: D006635:Histamine H2 Antagonists; D011899:Ranitidine