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Quinine-induced granulomatous hepatitis.

B Katz, M Weetch, S Chopra

    British Medical Journal (Clinical Research Ed.)
    |January 22, 1983
    PubMed
    Summary

    Quinine sulphate, used for leg cramps, can cause granulomatous hepatitis. This drug-induced liver injury is reversible upon quinine withdrawal, highlighting the need for careful consideration of this medication.

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    Area of Science:

    • Hepatology
    • Clinical Pharmacology
    • Toxicology

    Background:

    • Quinine sulphate is commonly prescribed for nocturnal leg cramps.
    • Adverse reactions to quinine are well-documented.
    • Granulomatous hepatitis is a rare liver condition often with an unknown cause.

    Observation:

    • A 65-year-old woman developed malaise, fever, nausea, vomiting, and polyarthralgia while taking quinine sulphate.
    • Granulomatous hepatitis was diagnosed, with no identifiable common cause.
    • Symptoms and liver enzyme elevations recurred upon quinine challenge and resolved after drug withdrawal.

    Findings:

    • The patient's clinical and biochemical response to quinine challenge strongly implicates the drug as the cause of her liver disease.
    • Erythrocyte sedimentation rate and transaminase activities increased significantly post-challenge.
    • The case demonstrates a clear link between quinine sulphate and drug-induced granulomatous hepatitis.

    Implications:

    • Quinine should be recognized as a potential cause of granulomatous hepatitis.
    • Clinicians should consider quinine as a causative agent in episodic liver disturbances, especially when other causes are not apparent.
    • This finding expands the known spectrum of quinine-induced adverse drug reactions.

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