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Cholangiolytic Changes in Statin-Induced Liver Injury
Preethi Dileep Menon1, Tamneet Singh2, Hopethe Hubbard2
1Department of Pathology and Laboratory Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA.
Case Reports in Pathology
|February 27, 2020
Summary
Atorvastatin, a common cholesterol drug, can cause liver injury. This case highlights unusual liver biopsy findings and emphasizes that stopping atorvastatin normalized liver function tests.
Area of Science:
- Hepatology
- Pharmacology
- Gastroenterology
Background:
- Atorvastatin is a widely prescribed statin for lowering cholesterol.
- Statin therapy, including atorvastatin, is associated with potential side effects like myalgia and headache.
- Drug-induced liver injury (DILI) is a known risk, with atorvastatin frequently implicated.
Observation:
- A 58-year-old woman on atorvastatin presented with recurrent abdominal pain and biliary tree dilation.
- Initial symptoms were attributed to post-surgical complications, despite elevated liver function tests.
- Liver biopsy revealed portal and lobular inflammation with cholangiolysis, indicating a mixed pattern of liver injury.
Findings:
- The patient displayed a mixed pattern of liver injury, characterized by elevated liver function tests.
- Histologic examination showed portal and lobular inflammation with cholangiolysis.
- Cessation of atorvastatin therapy led to the normalization of liver function tests.
Implications:
- This case underscores the importance of considering statin-induced hepatotoxicity in patients with unexplained liver function abnormalities.
- Unusual histologic findings, such as cholangiolysis, can be associated with atorvastatin-induced liver injury.
- Discontinuation of the offending statin agent is crucial for resolving drug-induced liver injury.
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