title: Severe chronic hepatitis secondary to prolonged use of ecstasy and cocaine.
abstract: OBJECTIVE
  Severe acute hepatotoxicity is a well known complication following the ingestion of ecstasy (3,4-methylenedioxymethamphetamine [MDMA] ecstasy). Hepatic dysfunction has also been reported after acute cocaine intoxication. However, chronic hepatitis after prolonged use of ecstasy and/or cocaine has rarely been reported.
  
  
  METHODS
  We report the case of a 27-year-old woman hospitalized with edema, ascites and severe liver failure (prothrombin rate 33%), following the use of ecstasy and cocaine over the previous 9 months. Clinical, biological, radiological and pathology findings were recorded at admission and over 8 years' follow-up.
  
  
  RESULTS
  Liver biopsy showed architectural distortion caused by bridging fibrosis, proliferation of cholangioles, and lesions of active interface hepatitis. Other causes of acute and chronic liver disease were excluded. Magnetic resonance imaging showed marked liver fibrosis. After withdrawal of both substances clinical examination and liver function tests progressively normalized. Long-term monitoring with magnetic resonance imaging showed progressive regression of fibrosis.
  
  
  CONCLUSIONS
  Use of ecstasy and cocaine may cause chronic hepatitis leading to marked liver fibrosis, which may regress after withdrawal of both substances.
authors.affiliation: Service d'hépato-gastroentérologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Payancé
authors.forename: Béatrice
authors.initials: B
authors.lastname: Scotto
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Perarnau
authors.forename: Anne
authors.initials: A
authors.lastname: de Muret
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bacq
mesh_terms: D000328:Adult; D001201:Ascites / Q000139:chemically induced; D001706:Biopsy; D056487:Chemical and Drug Induced Liver Injury, Chronic / Q000209:etiology* / Q000473:pathology; D003042:Cocaine / Q000009:adverse effects*; D005260:Female; D006213:Hallucinogens / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000473:pathology; D017093:Liver Failure / Q000139:chemically induced; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D009294:Narcotics / Q000009:adverse effects*; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D006213:Hallucinogens; D009294:Narcotics; D003042:Cocaine; D018817:N-Methyl-3,4-methylenedioxyamphetamine