title: Acute hepatotoxicity caused by enalapril: a case report.
abstract: A case of enalapril-induced acute hepatotoxicity with an unusual morphology is described. This morphology was characterized by macro- and microvesicular steatosis associated with neutrophil infiltration and Mallory bodies, occasionally with satellitosis. These alterations were most abundant in zone 1 of the periportal region, less common in zone 2 and rare in zone 3. There was also confluent periportal necrosis with sinusoidal fibrin deposits associated with intense ductal metaplasia and an infiltrate of inflammatory cells that included plasmocytes and a few eosinophils, as well as focal biliary damage. This morphology, that may be referred as "predominantly periportal steatohepatitis", was distinct from that associated with non-alcohol and alcohol-induced steatohepatitis, both initiated in acinar zone 3 and subsequently extended to other zones.
authors.affiliation: Department of Pathology, Department of Medicine, Faculty of Medical Sciences, State University of Campinas, Sao Paulo, Brazil. gustavohs@puc-campinas.edu.br
authors.forename: Gustavo Henrique
authors.initials: GH
authors.lastname: da Silva
authors.forename: Almerinda Vieira Fernandes Ribeiro
authors.initials: AV
authors.lastname: Alves
authors.forename: Pedro
authors.initials: P
authors.lastname: Duques
authors.forename: Tiago
authors.initials: T
authors.lastname: Sevá-Pereira
authors.forename: Elza Cotrim
authors.initials: EC
authors.lastname: Soares
authors.forename: Cecilia Amelia Fazzio
authors.initials: CA
authors.lastname: Escanhoela
mesh_terms: D000208:Acute Disease; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D004656:Enalapril / Q000009:adverse effects*; D005234:Fatty Liver / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008297:Male; D009336:Necrosis; D020556:Neutrophil Infiltration / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004656:Enalapril