Gold: hepatotoxic and cholestatic reactions

Gold hepatotoxicity is an uncommon but significant clinical problem. Hepatitis was first manifested one day to four weeks after the last dose of gold at a cumulative range of 35 to 2900 mg. An interesting dichotomy was noted between cholestatic and hepatotoxic reactions. Hepatotoxic reactions were associated with other clinical signs of hypersensitivity, thus facilitating differential diagnosis from viral hepatitis. Sudden clinical improvement in a patient receiving gold should stimulate evaluation for a hepatotoxic reaction.