Atorvastatin-induced prolonged cholestasis with bile duct damage.
We report a case of acute-onset, long-lasting cholestasis induced by atorvastatin. This antihyperlipidaemic drug was taken for 40 days by a 72-year-old male as a treatment for his mixed dyslipidaemia. At that point, the patient presented with asthenia, nausea, painless icterus, acholic stools and hyperchromic urine with biochemical analyses showing a dramatic increase in bilirubin (total bilirubin 22 mg/dL; direct bilirubin 21 mg/dL) and alkaline phosphatase (up to 4-fold over the normal level) with less marked increases in transaminases. Liver histology showed a pattern of cholestasis with evident signs of cholangiolitis and damage of the interlobular bile ducts. Serum transaminase and bilirubin levels returned to normal within 5 months after atorvastatin withdrawal while alkaline phosphatase normalized after only 8 months. Scores on both the Maria and Victorino clinical scale for the diagnosis of drug-induced hepatitis and the Naranjo Adverse Drug Reaction Probability Scale indicated that atorvastatin was the probable cause of prolonged cholestasis in this patient. This is a rare case of cholestasis probably caused by atorvastatin and unusually characterized by bile duct damage.
Division of Gastroenterology, Department of Clinical Medicine, University of Rome 'Sapienza', Rome, Italy.
Manuela
M
Merli
Maria Consiglia
MC
Bragazzi
Federica
F
Giubilo
Francesco
F
Callea
Adolfo F
AF
Attili
Domenico
D
Alvaro
D000368:Aged; D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069059:Atorvastatin; D001652:Bile Ducts / Q000187:drug effects* / Q000473:pathology; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002761:Cholangitis / Q000139:chemically induced* / Q000188:drug therapy; D002779:Cholestasis / Q000139:chemically induced* / Q000188:drug therapy; D050171:Dyslipidemias / Q000188:drug therapy; D006538:Heptanoic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D002756:Cholagogues and Choleretics; D006538:Heptanoic Acids; D011758:Pyrroles; D014580:Ursodeoxycholic Acid; D000069059:Atorvastatin