Hepatitis aguda tóxico-medicamentosa de evolución tórpida e infrecuente

Resumen

We report the case of a 52 year old woman who presented, 12 days after initiating treatment with Captopril ®, a picture of asthenia and jaundice, with total bilirubin of 28.5 mg/dL, direct bilirubin of 27.4 mg/dL, GOT 933 U/L, GPT of 1486 U/L and a V factor of 18%. The cessation in the administration of the said drug was associated with a decrease in liver enzymes and in total bilirubin. But several days later, the level increased again to 37 mg/dL and a comprehensive etiological study showed positive AMA, so that the patient started a treatment with prednisone, with a suspected overlap syndrome without analytical improvement. However, a liver biopsy showed a cholestatic liver with normal portal tracts and no evidence of autoimmune hepatitis, so finally the diagnosis made was that of toxic hepatitis caused by Captopril ®. Acute injuries caused by this drug usually have cholestatic features, although hepatocellular and cholestatic injuries have also been reported, and sometimes a prolonged course has been described, including chronic liver damage with cholestatic or mixed pattern even when the drug ceased to be administered.