Haloperidol-induced chronic cholestatic liver disease

A 15-yr-old patient with chronic cholestatic liver disease associated with haloperidol therapy is presented. Emphasis is placed on the pattern of biochemical abnormalities and on the histologic features observed in the four serial biopsies which demonstrated a pronounced injury to the bile duct epithelium, correlating well with the clinical and biochemical abnormalities. During the early stage of illness, the clinicopathologic features simulated obstructive jaundice, whereas a resemblance to chronic chlorpromazine-induced cholestasis or primary biliary cirrhosislike syndrome was striking as the chronicity developed. Comparison is made of the features in our patient with those in 2 patients with biopsy-documented, acute haloperidol-induced liver disease reported for the first time in 1977. Despite the lack of concrete evidence, both the clinical and morphologic features, and the close temporal relationship between the medication and onset of illness in this patient led to the reasonable inference that haloperidol was responsible for the chronic cholestatic reaction on a hypersensitivity basis.