Case report: mixed cholestatic/hepatocellular liver injury induced by the herbicide quizalofop-p-ethyl.
BACKGROUND
Quizalofop-p-ethyl is an often applied, slightly toxic herbicide for which no severe toxicity has been reported in humans.


METHODS
We present the case of a farmer exposed to quizalofop-p-ethyl who presented with obstructive cholestasis. A complete workup disclosed no other cause of liver pathology, but liver biopsy established drug-induced hepatotoxicity. The patient was treated with ursodeoxycholic acid and prednisolone, and was recovered fully 70 days after his exposure to the herbicide. The patient was followed for the next 9 months.


CONCLUSIONS
Quizalofop-p-ethyl can induce a mixed cholestatic/hepatocellular liver injury. We discuss possible mechanisms implicated in liver injury after exposure to quizalofop-p-ethyl.


CONCLUSIONS
In patients presenting with mixed cholestatic/ hepatocellular liver injury, occupational exposure to quizalofop-p-ethyl in the course of agricultural use should be investigated.
Elefsiniotis
Ioannis S
IS
Department of Internal Medicine, Hepatology Unit, Hippokration General Hospital, Athens, Greece.
Liatsos
George D
GD
Stamelakis
Dimitris
D
Moulakakis
Antonios
A
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001647:Bile Acids and Salts / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000473:pathology*; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000188:drug therapy; D004781:Environmental Exposure; D006540:Herbicides / Q000633:toxicity*; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011422:Propionates / Q000633:toxicity*; D011810:Quinoxalines / Q000633:toxicity*; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D001647:Bile Acids and Salts; D006540:Herbicides; D011422:Propionates; D011810:Quinoxalines; D014580:Ursodeoxycholic Acid; C064835:quizalofop-ethyl; D011239:Prednisolone