A case of indometacin-induced acute hepatitis developing into chronic autoimmune hepatitis.
BACKGROUND
A 47-year-old woman who presented with hip pain as a result of osteoarthritis was treated with indometacin. Ten days after beginning treatment she developed jaundice and ascites. All medications were discontinued, but her symptoms continued to worsen.


METHODS
Physical examination, laboratory tests and radiologic examinations, including liver chemistry tests, viral serologies, serum iron studies, ceruloplasmin and alpha-fetoprotein analyses, autoimmune serologies, ascites studies, abdominal CT, liver ultrasound and liver biopsy.


METHODS
Severe biopsy-proven hepatitis that progressed to chronic autoimmune hepatitis.


RESULTS
Treatment with prednisone 40 mg/day was initially successful. The dose of the therapy was tapered over 18 months and then discontinued, after which time the patient's liver chemistry test results worsened. Repeat liver biopsy samples showed evidence of chronic hepatitis, and her liver chemistry test results improved when prednisone was restarted. The patient was maintained on 750 mg twice-daily mycophenolate mofetil and prednisone was decreased to 5 mg every other day.
Abraham
Clara
C
Yale University School of Medicine, Department of Internal Medicine, Section of Digestive Diseases, 333 Cedar St/1080 LMP, PO Box 208019, New Haven, CT 06520-8019, USA. clara.abraham@yale.edu
Hart
John
J
Locke
Susan M
SM
Baker
Alfred L
AL
D000208:Acute Disease; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D056487:Chemical and Drug Induced Liver Injury, Chronic / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects*; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin