title: Prolonged intrahepatic cholestasis after exposure to loxoprofen.
abstract: OBJECTIVE
  The objective of this report was to describe a case of prolonged intrahepatic cholestasis likely associated with the use of loxoprofen, a phenylpropionate NSAID.
  
  
  METHODS
  A 36-year-old female patient was transferred to Gunma University Hospital, Maebashi, Japan, with progressive pruritus and jaundice that developed after 5-day treatment with 120 mg/d of loxoprofen (maximum recommended dose, 180 mg/d) for menstrual pain. Liver function tests found the following concentrations: total bilirubin, 27.5 mg/dL (normal [nl] range, 0.3-1.2 mg/dL); aspartate aminotransferase, 151 IU/L (nl, 13-33 IU/L); alkaine aminotransferase, 470 IU/L (nl, 8-42 IU/L); alkaline phosphatase, 1082 IU/L (n1, 115-359 IUAL); and gamma-glutamyl transpeptidase, 795 IU/L (nl, 10-47 IU/L) indicative of intrahepatic cholestasis. No use of alcohol or other drugs or herbal products was reported. The patient had a history of elevated hepatic enzymes of unknown origin following the use of mefenamic acid. The patient was prescribed ursodeoxycholic acid 3 weeks after the onset of symptoms of intrahepatic cholestasis. Thereafter, due to progressive cholestasis, an IV pulse of methylprednisolone (1000 mg/d) and the herbal product Inchin-ko-to (TJ-135) were administered. Plasma bilirubin adsorption (PA) and plasma exchange (PE) were performed.
  
  
  RESULTS
  Following treatment with PA and PE for 3 weeks with administration of methylprednisolone and Inchin-ko-to, signs and symptoms of intrahepatic cholestasis began to resolve (3.5 months after the onset); they were completely resolved 8 months after the initial episode. A Naranjo scale score of 6 suggested that loxoprofen was likely the cause of the prolonged cholestasis in this patient.
  
  
  CONCLUSIONS
  Based on the Naranjo score, this case of prolonged intrahepatic cholestasis in a young woman was likely associated with loxoprofen use.
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan. itikawat@med.gunma-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Hiroko
authors.initials: H
authors.lastname: Sato
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Kaira
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Oh-I
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.forename: Masatomo
authors.initials: M
authors.lastname: Mori
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000150:complications / Q000628:therapy; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000175:diagnosis; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D010666:Phenylpropionates / Q000009:adverse effects* / Q000627:therapeutic use; D010951:Plasma Exchange / Q000379:methods; D011537:Pruritus / Q000150:complications / Q000175:diagnosis; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004365:Drugs, Chinese Herbal; D010666:Phenylpropionates; C078038:inchinko-to; C040656:loxoprofen; D001663:Bilirubin; D008775:Methylprednisolone