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Quinine hepatotoxicity. An underrecognized or rare phenomenon?
R C Punukollu1, S Kumar, K D Mullen
1Department of Medicine, Cleveland Metropolitan General Hospital, Case Western Reserve University, Ohio.
Archives of Internal Medicine
|May 1, 1990
Summary
Quinine hypersensitivity can cause liver injury mimicking viral illness. This rare condition, distinct from quinidine reactions, highlights the need for vigilance in diagnosing drug-induced liver damage.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Toxicology
Background:
- Drug-induced liver injury (DILI) is a significant clinical concern.
- Quinine is primarily used for malaria and certain arrhythmias.
- Hepatic injury from quinine is exceptionally rare in medical literature.
Observation:
- A patient presented with symptoms resembling a viral illness.
- The patient exhibited a mixed hepatocellular-cholestatic pattern of liver injury.
- This presentation was attributed to an apparent hypersensitivity to quinine.
Findings:
- The case demonstrates a rare instance of quinine-induced hepatotoxicity.
- The clinical and biochemical profile mimicked viral hepatitis.
- Literature review revealed limited reports of quinine DILI, contrasting with more frequent quinidine-induced liver injury.
Implications:
- Clinicians should consider quinine as a potential cause of DILI, especially with overlapping symptoms.
- Differentiating drug-induced reactions from infections is crucial for appropriate management.
- Further investigation into the mechanisms of quinine hepatotoxicity may be warranted.