Acute hepatocellular and cholestatic injury during therapy with hydrochlorothiazide - clinicohistopathologic findings: a case report.
BACKGROUND
Hydrochlorothiazide and thiazide-like diuretics are considered first-line drugs for initial therapy in uncomplicated arterial hypertension. Acute cholecystitis is a well-known complication during treatment with thiazide, and these drugs are also reported to be followed by pronounced insulin resistance.


METHODS
We describe a case of acute cholestatic hepatitis in a 68-year-old Caucasian man who was receiving olmesartan and hydrochlorothiazide for arterial hypertension. From the clinical and histologic findings, we diagnosed him as having hepatocellular-cholestatic injury and a disorder of glucose metabolism in the liver. To the best of our knowledge, no histopathologic description of hydrochlorothiazide hepatotoxicity has previously been documented in the literature.


CONCLUSIONS
In the differential diagnosis of cholestatic hepatitis, clinicians should be aware of the possibility of liver damage in patients receiving hydrochlorothiazide therapy.
II Division of Infectious Diseases, Istituto Nazionale per le Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico 'Lazzaro Spallanzani', Rome, Italy. taglietti.f@gmail.com.
Fabrizio
F
Taglietti
Franca
F
Del Nonno
Andrea
A
Baiocchini
Laura
L
Falasca
Stefano
S
Pieri
Alessandro
A
Capone
Elisabetta
E
Grilli
Pierangelo
P
Chinello
Nicola
N
Petrosillo