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Drug-induced acute cholestatic liver damage in a patient with mutation of UGT1A1
Igino Rigato1, Monica Cravatari, Claudio Avellini
1Centro Studi Fegato, AREA Science Park, Basovizza, Trieste, Italy. igino.rigato@csf.units.it
Background:
A 54-year-old woman presented with a 3-week history of fatigue and with jaundice that began 2 days before admission. She had been undergoing treatment with flavoxate for urinary incontinence (for 2 months before admission) and with tibolone for climacteric syndrome (for 6 months before admission). Laboratory tests revealed elevated concentrations of aminotransferases, bilirubin, gamma-glutamyltransferase and alkaline phosphatase. Liver biopsy revealed histological evidence of subacute, drug-induced liver damage.
Investigations:
Physical examination, liver function tests, serology tests, autoantibody tests, genetic analysis of the TATA box of the UGT1A1 gene, ultrasonography and CT scan; MRI cholangiography; liver biopsy.
Diagnosis:
Drug-related hepatitis in a patient with Gilbert's syndrome.
Management:
Flavoxate and tibolone were discontinued. Liver function test results improved progressively and normalized after almost 2 months.
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