Drug-induced acute cholestatic liver damage in a patient with mutation of UGT1A1.
BACKGROUND
A 54-year-old woman presented with a 3-week history of fatigue and with jaundice that began 2 days before admission. She had been undergoing treatment with flavoxate for urinary incontinence (for 2 months before admission) and with tibolone for climacteric syndrome (for 6 months before admission). Laboratory tests revealed elevated concentrations of aminotransferases, bilirubin, gamma-glutamyltransferase and alkaline phosphatase. Liver biopsy revealed histological evidence of subacute, drug-induced liver damage.


METHODS
Physical examination, liver function tests, serology tests, autoantibody tests, genetic analysis of the TATA box of the UGT1A1 gene, ultrasonography and CT scan; MRI cholangiography; liver biopsy.


METHODS
Drug-related hepatitis in a patient with Gilbert's syndrome.


RESULTS
Flavoxate and tibolone were discontinued. Liver function test results improved progressively and normalized after almost 2 months.
Rigato
Igino
I
Centro Studi Fegato, AREA Science Park, Basovizza, Trieste, Italy. igino.rigato@csf.units.it
Cravatari
Monica
M
Avellini
Claudio
C
Ponte
Euro
E
Crocè
Saveria Lory
SL
Tiribelli
Claudio
C
D000208:Acute Disease; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000209:etiology* / Q000473:pathology; D002979:Climacteric; D005260:Female; D005422:Flavoxate / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D005878:Gilbert Disease / Q000150:complications / Q000235:genetics*; D014453:Glucuronosyltransferase / Q000235:genetics*; D006801:Humans; D007150:Immunohistochemistry; D008111:Liver Function Tests; D008875:Middle Aged; D009154:Mutation; D009652:Norpregnenes / Q000009:adverse effects* / Q000627:therapeutic use; D018570:Risk Assessment; D014549:Urinary Incontinence / Q000150:complications / Q000188:drug therapy; D000099148:UGT1A1 Enzyme
D005422:Flavoxate; D014453:Glucuronosyltransferase; D009652:Norpregnenes; D000099148:UGT1A1 Enzyme; C027385:tibolone