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[Cirrhogenic hepatitis due to perhexiline maleate: general review based upon one new case with ultrastructural study
Insights
Perhexiline maleate, used for angina, can cause liver cirrhosis. This case highlights the drug
Area of Science:
- Hepatology
- Toxicology
- Pharmacology
Background:
- Perhexiline maleate is a medication prescribed for severe angina pectoris.
- Drug-induced liver injury is a significant concern in clinical practice.
- Cirrhosis is a severe form of liver damage with various etiologies.
Observation:
- A case of cirrhogenic hepatitis developed after 8 months of perhexiline maleate treatment.
- The patient presented with liver cirrhosis, which was the initial manifestation of the condition.
- Cirrhosis appeared to stabilize after discontinuation of the drug.
Findings:
- The liver injury exhibited a cirrhogenic evolution, consistent with previously reported cases.
- Mechanisms may involve cumulative drug effects or an immuno-allergic response.
- Distinctive features include lysosomal overload with brown pigment and lipolysosomes, observable microscopically and electron microscopically.
Implications:
- Perhexiline maleate prescription should be restricted to refractory angina cases.
- Regular clinical and biological monitoring is crucial for patients on this medication.
- Understanding the toxicological profile of perhexiline maleate is essential for patient safety.
Abstract:
The authors describe a case of cirrhogenic hepatitis due to Pexid which was given for 8 months at 400 mg/day for a severe angina pectoris. We find here the anatomo-clinical profile of perhexiline maleate hepatiits already described in approximately 20 cases. There was a cirrhogenic evolution in our case as in 5 others : but here cirrhosis was revealing and seems stabilized since the treatment was stopped. The cirrhogenic evolution could be due to a cumulative effect of the drug and/or to an immuno-allergic mechanism as in alcoholic cirrhosis which is very similar, especially from an anatomical point of view. However cirrhogenic hepatitis differs by a characteristic lysosomal overload : brown pigment under microscopic observation and lipolysosomes with in some cases a lamellar structure under electron microscopic observation. The prescription of such a drug should be limited to cases of refractory angina pectoris and needed a regular clinical and biological survey.