Steroid Therapy for a Case of Severe Drug-Induced Cholestasis

Giannattasio, Antonietta; D’Ambrosi, Mariangela; Volpicelli, M; Iorio, Raffaele

doi:10.1345/aph.1g345

Cited by 37 publications

(20 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…106 Corticosteroids too may be attempted in select cases of cholestasis or cholestatic hepatitis particularly those associated with features of hypersensitivity such as skin rashes, and fever. 107 Antiepileptic drugs with its increased predisposition to hypersensitivity syndrome and DILI may particularly respond to steroids. However, the conclusive efficacy of steroids and UDCA await controlled studies.…”

Section: Management Of Patients With Drug-induced Liver Injurymentioning

confidence: 99%

An Update on Drug-induced Liver Injury

Devarbhavi

2012

Journal of Clinical and Experimental Hepatology

143

101

View full text Add to dashboard Cite

Section: Management Of Patients With Drug-induced Liver Injurymentioning

confidence: 99%

An Update on Drug-induced Liver Injury

Devarbhavi

2012

Journal of Clinical and Experimental Hepatology

143

101

View full text Add to dashboard Cite

“…For this reason, and although no controlled trials have been performed to Fig. 1 Ultrasound-guided liver biopsy performed at day 41 from cessation of therapy with amoxicillin-clavulanate, revealing severe canalicular cholestasis with bile plugs in dilated bile canaliculi, ductopenia, fibrosis, giant cell transformation, steatosis, portal and lobular eosinophilic infiltrates, and necrosis predominating in the central zones, suggestive of drug reaction (H&E stain, ×250) ascertain its efficacy [16], corticosteroid treatment is considered for patients with severe jaundice [7]. In our case, we employed an initial dose of 1 mg/kg/day, similar to that recommended for autoimmune hepatitis [17], followed by a progressive descent guided by the clinical and laboratory test responses.…”

Section: Discussionmentioning

confidence: 99%

“…Except for the withdrawal of the drug, there is no specific therapy for this condition [1]. Corticosteroid treatment has been suggested [5] and occasionally reported [6,7].…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid Therapy in a Case of Severe Cholestasic Hepatitis Associated with Amoxicillin–Clavulanate

Herrero‐Herrero

García-Aparicio

2010

J. Med. Toxicol.

View full text Add to dashboard Cite

Amoxicillin-clavulanate is the most common drug involved in drug-induced liver injury and the single most frequently prescribed product leading to hospitalization for drug-induced liver disease in Spain. The liver damage most frequently associated with amoxicillinclavulanate is cholestasic type. The latency period between first intake and onset of symptoms is 3-4 weeks on average. A 76-year-old man developed fever, pruritus, and jaundice 3 weeks after having completed treatment with amoxicillin-clavulanate. Liver function tests showed cholestasic hepatitis (up to 50.75 mg/dL of total serum bilirubin level). The ultrasound-guided liver biopsy revealed severe canalicular cholestasis and portal and lobular eosinophilic infiltrates. Prednisone and ursodeoxycholic acid therapy were then prescribed. The patient became symptom-free with normal liver function tests. Amoxicillin-clavulanate can cause hepatocellular, cholestasic, or mixed liver injury. The presence of eosinophilic infiltrates in the liver biopsy and the clinical signs of hypersensitivity in some of the cholestasic cases suggest a pathophysiological immunoallergic mechanism. For this reason, corticosteroid treatment should be considered for patients with severe cholestasic liver injury.

show abstract

“…The role of steroids in the management of drug-related cholestatic hepatitis in adults successfully has been reported [9,10]. But all cases had no history of diabetes that described the use of steroids therapy.…”

Section: Discussionmentioning

confidence: 99%

Steroids for the treatment of methimazole-induced severe cholestatic jaundice in a 74-year-old woman with type 2 diabetes

Zhang

Zhou

et al. 2010

Endocr

View full text Add to dashboard Cite

Methimazole is a widely used antithyroid agent. Although methimazole is generally well tolerated, rare but severe cholestatic jaundice may occur. We described a 74-year-old woman who had a 10-year history of type 2 diabetes had developed severe jaundice and itching 1 month after receiving methimazole (10 mg tid) and propranolol (10 mg tid) for the treatment of hyperthyroidism. Clinical investigations revealed no evidence of any mechanical obstruction in the common bile duct or other obvious causes of hepatic injury, and the diagnosis methimazole-induced cholestasis was made on the basis of the temporal relationship between initiation of methimazole and onset of cholestasis. Methimazole was hence discontinued. However, the patient experienced a progressive worsening in cholestasis after receiving 2 weeks of ursodeoxycholic acid (UDCA) therapy. Prednisone therapy was then attempted. Liver function tests eventually improved with combination of glucocorticoids and ursodeoxycholic acid therapy. This case clearly showed that glucocorticoids could be a possible additional way of treatment for some cases of drug-induced cholestatic jaundice even in diabetic patients.

show abstract

Steroid Therapy for a Case of Severe Drug-Induced Cholestasis

Cited by 37 publications

References 23 publications

An Update on Drug-induced Liver Injury

An Update on Drug-induced Liver Injury

Corticosteroid Therapy in a Case of Severe Cholestasic Hepatitis Associated with Amoxicillin–Clavulanate

Steroids for the treatment of methimazole-induced severe cholestatic jaundice in a 74-year-old woman with type 2 diabetes

Contact Info

Product

Resources

About