A case of cholestatic hepatitis associated with D-penicillamine therapy for rheumatoid arthritis

A male aged 72 years suffering from erosive seropositive rheumatoid arthritis developed jaundice after one month on D-penicillamine after a cumulative dose of 5.625 g. The biological abnormalities were characteristic of cholestasis. There were no gall-stones. The liver biopsy showed severe intrahepatocellular cholestasis with a slight degree of cellular cholangitis and with eosinophils in the portal tracts. There was no sign of cellular necrosis. After cessation of D-penicillamine, the jaundice cleared within three weeks and the enzymes were normalized within two months. The aetiology is discussed and the cases of the literature are reviewed. This case represents a further instance of D-penicillamine-induced cholestatic hepatitis.