[A case of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis].
Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.
Yoon
Jae Young
JY
Department of Internal Medicine, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.
Min
Sun Yang
SY
Park
Ju Yee
JY
Hong
Seung Goun
SG
Park
Sang Jong
SJ
Paik
So Ya
SY
Park
Young Min
YM
D000368:Aged; D000493:Allopurinol / Q000009:adverse effects* / Q000627:therapeutic use; D000963:Antimetabolites / Q000009:adverse effects* / Q000627:therapeutic use; D001649:Bile Duct Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects* / Q000473:pathology; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D002779:Cholestasis / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D003875:Drug Eruptions / Q000473:pathology; D006099:Granuloma / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male
D000963:Antimetabolites; D000493:Allopurinol