Chlorpropamide-induced cholestatic liver failure resulting in death

To describe the first reported case of a death that occurred as a result of chlorpropamide-induced cholestatic liver disease.

We review the clinical and laboratory details of an 81-year-old man with type II diabetes mellitus, who was hospitalized because of nausea, vomiting, and jaundice.

The patient had been taking a sulfonylurea (chlorpropamide, 250 mg orally three times a day) for 2 months. On initial assessment, the patient was noted to have cutaneous and scleral icterus and an erythematous maculopapular rash on the torso. The alkaline phosphatase level was substantially increased, and the transaminases were mildly increased. Use of all medications was discontinued. In the hospital, the patient's status rapidly deteriorated, and death ensued after cardiopulmonary arrest on day 6.

The findings were consistent with a hypersensitivity reaction to chlorpropamide that ultimately resulted in fulminant cholestatic liver disease and death.