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Prolonged cholestasis after ajmaline-induced acute hepatitis
Journal of Hepatology
|January 1, 1986
Summary
Ajmaline can cause acute hepatitis and prolonged cholestasis lasting over a year, even after drug withdrawal. This suggests a potential autoimmune response to ajmaline-induced liver injury.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Immunology
Background:
- Ajmaline is an antiarrhythmic drug.
- Drug-induced liver injury (DILI) can manifest in various forms.
- Prolonged cholestasis is a less common but significant adverse effect of certain medications.
Observation:
- Three patients developed acute hepatitis after 8-16 days of ajmaline treatment.
- Symptoms included fever, chills, abdominal pain, and jaundice, with associated hypereosinophilia.
- Histological findings revealed centrilobular cholestasis and portal inflammation.
Findings:
- Jaundice persisted for 3 weeks to 11 months.
- Liver tests remained abnormal 17-26 months post-ajmaline cessation.
- Histology showed decreased bile ducts, ductular proliferation, and fibrosis, with evidence of circulating immune complexes.
Implications:
- Ajmaline can lead to prolonged cholestasis and persistent liver abnormalities.
- The findings suggest a possible autoimmune mechanism in ajmaline-induced liver injury.
- This highlights the importance of monitoring liver function in patients treated with ajmaline.