[Cholestasic toxic hepatitis due to clopidogrel in a patient with multiple conditions]

Area of Science:

• Pharmacology
• Hepatology
• Internal Medicine

Background:

• Clopidogrel is a widely used thienopyridine antiplatelet agent for cardiovascular and cerebrovascular conditions.
• Drug-induced liver injury from clopidogrel is exceptionally rare, with limited literature and few liver biopsy reports.
• Cholestatic hepatitis is a potential adverse effect of clopidogrel therapy.

Purpose of the Study:

• To report a case of severe toxic cholestatic hepatitis secondary to clopidogrel.
• To review the clinical characteristics, diagnosis, and management of clopidogrel-induced liver injury.
• To underscore the importance of considering clopidogrel as a cause of hepatitis in susceptible patients.

Main Methods:

• Case report of a 78-year-old patient with multiple comorbidities.
• Review of 16 previously reported cases of clopidogrel-induced liver toxicity.
• Analysis of liver biopsy findings in the presented case and literature.

Main Results:

• The patient presented with severe toxic cholestatic hepatitis, confirmed by liver biopsy.
• Hepatitis symptoms resolved completely after clopidogrel discontinuation.
• Literature review identified a pattern of presentation and recovery in clopidogrel-induced liver injury.

Conclusions:

• Clopidogrel can cause severe cholestatic hepatitis, although infrequent.
• Prompt drug withdrawal is crucial for managing clopidogrel-induced liver injury.
• Increased clinical suspicion and awareness are necessary for timely diagnosis and treatment.