Cholestatic jaundice caused by D-penicillamine

Area of Science:

• Hepatology
• Nephrology
• Rheumatology

Background:

• D-penicillamine is a chelating agent used in treating rheumatoid arthritis and Wilson's disease.
• It is not typically associated with significant hepatotoxicity.

Observation:

• A patient with rheumatoid arthritis developed cholestatic jaundice four weeks after initiating D-penicillamine therapy.
• The patient subsequently experienced acute renal failure and passed away.

Findings:

• The case presents a potential link between D-penicillamine and severe cholestatic liver injury.
• The probability of D-penicillamine being the causative agent for the observed cholestasis is evaluated.

Implications:

• This case highlights a rare but severe adverse reaction to D-penicillamine, emphasizing the need for vigilant monitoring.
• Clinicians should consider D-penicillamine-induced liver injury in patients presenting with jaundice, even with a history of rheumatoid arthritis.