No abstract

We describe a 75-year-old patient who presented with severe cholestatic liver disease. He had been receiving methyldopa, 250 mg daily, for 6 years. An extensive evaluation failed to reveal extrahepatic obstruction or serologic evidence of viral hepatitis. A liver biopsy disclosed marked cholestasis, without hepatitis, and was compatible with a rare form of methyldopa-induced liver injury. Cessation of drug treatment was followed by a slow but complete recovery. Cholestasis is a rare manifestation of methyldopa hepatotoxicity. Although methyldopa-associated liver injury usually appears after about 4 weeks of treatment, a history of a much longer exposure does not exclude this entity.

Background: Lidocaine has been commonly used in many clinical settings. Nonetheless, systemic toxicity can be life-threatening and careful attention to dosing, especially among patients with liver dysfunction is important to minimize the risk of toxicity. Objective: The diagnosis of lidocaine toxicity is usually clinical, while rare, but may prove fatal. Methods: Here we discuss 60 years-old man with advanced liver cirrhosis, developed lidocaine-induced cardiovascular and neurotoxicity. Results: Our case study demonstrates a successful treatment of cardiovascular and neurotoxicity with intravenous lipid emulsion in the context of systemic lidocaine toxicity in a liver cirrhosis patient who received lidocaine as a local anesthetic. Conclusions: A high index of suspicion should be maintained for severe toxicity even after subcutaneous administration and prompt intralipid administration may prove lifesaving.