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Updated: Jun 11, 2026
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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
Published on: November 27, 2019
Acute hepatotoxicity caused by enalapril: a case report
Gustavo Henrique da Silva1, Almerinda Vieira Fernandes Ribeiro Alves, Pedro Duques
1Department of Pathology, Department of Medicine, Faculty of Medical Sciences, State University of Campinas, Sao Paulo, Brazil. gustavohs@puc-campinas.edu.br
Summary
Enalapril can cause acute liver injury with a unique pattern of fat accumulation and inflammation primarily in the periportal area. This drug-induced liver injury differs from other forms of steatohepatitis.
Area of Science:
- Hepatology
- Toxicology
- Pathology
Background:
- Drug-induced liver injury (DILI) is a significant clinical concern.
- Enalapril, an angiotensin-converting enzyme inhibitor, is widely prescribed.
- Unusual presentations of DILI require detailed characterization.
Observation:
- A case of acute hepatotoxicity attributed to enalapril was observed.
- Histological examination revealed macro- and microvesicular steatosis, neutrophil infiltration, and Mallory bodies.
- These changes were predominantly localized to zone 1 (periportal region).
Findings:
- The observed liver injury exhibited confluent periportal necrosis and sinusoidal fibrin deposition.
- Intense ductal metaplasia and inflammatory infiltrates, including plasmocytes and eosinophils, were noted.
- Focal biliary damage was also present.
- This distinct morphology was termed "predominantly periportal steatohepatitis".
Implications:
- The identified morphology is distinct from alcohol- and non-alcohol-induced steatohepatitis, which typically originate in zone 3.
- This case highlights the diverse histological patterns of enalapril-induced liver injury.
- Recognizing this specific pattern is crucial for accurate diagnosis and management of DILI.
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