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Severe cholestatic jaundice associated with piroxicam
K S Hepps1, G M Maliha, R Estrada
1Department of Medicine, Baylor College of Medicine, Houston, Texas.
Gastroenterology
|December 1, 1991
Summary
Piroxicam, a nonsteroidal anti-inflammatory drug, can cause severe intrahepatic cholestasis, a liver injury. This case highlights the importance of considering drug-induced liver toxicity in patients presenting with jaundice.
Area of Science:
- Hepatology
- Pharmacology
- Gastroenterology
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disease.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like piroxicam are commonly used for RA symptom management.
- Drug-induced liver injury (DILI) is a significant concern in pharmacotherapy.
Observation:
- A 62-year-old male with RA developed jaundice and abnormal liver function tests.
- The patient was taking piroxicam, an NSAID.
- Extensive investigations, including imaging and biopsy, confirmed intrahepatic cholestasis.
Findings:
- Piroxicam was identified as the likely cause of severe cholestatic jaundice.
- The patient's liver function normalized within 4 months of discontinuing piroxicam.
- This represents the first reported case of severe piroxicam-associated liver toxicity in the United States.
Implications:
- Piroxicam should be considered in the differential diagnosis of cholestatic jaundice, especially when common causes are ruled out.
- Clinicians should be vigilant for potential liver toxicity with piroxicam use.
- Further research into NSAID-induced hepatotoxicity is warranted.
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