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Published on: December 18, 2013
Acute liver failure due to enalapril
M Jeserich1, C Ihling, H P Allgaier
1Department of Pathology, Medizinische Universitätsklinik Freiburg, Germany. info@Praxis-Jeserich.de
Herz
|January 6, 2001
Summary
Long-term use of enalapril, an angiotensin-converting-enzyme (ACE) inhibitor, can lead to severe liver failure. This case highlights the risk of drug-induced liver damage even after prolonged treatment, necessitating regular monitoring of liver enzymes.
Area of Science:
- Hepatology
- Pharmacology
- Clinical Medicine
Background:
- Hypertension is commonly treated with angiotensin-converting-enzyme (ACE) inhibitors like enalapril.
- Drug-induced liver injury (DILI) is a significant concern in pharmacotherapy.
- Long-term effects of ACE inhibitors on liver function require ongoing investigation.
Observation:
- A 46-year-old male developed jaundice and progressive liver failure after 3 years of enalapril treatment for hypertension.
- Liver damage persisted despite discontinuation of enalapril.
- Exclusion of other causes pointed towards drug-induced liver damage.
Findings:
- Liver biopsy findings were similar to severe halothane hepatitis.
- Serological tests for T-cell stimulation and autoimmunity, including anti-calreticulin antibodies, were negative.
- The precise mechanism of enalapril-induced liver injury remains undetermined.
Implications:
- This case represents the longest documented duration of ACE inhibitor treatment preceding liver failure.
- Liver failure progressed despite drug withdrawal, indicating potential irreversible damage.
- Regular monitoring of liver enzymes is recommended for patients on long-term ACE inhibitor therapy to detect potential liver injury early.
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