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Terbinafine-induced prolonged cholestasis with reduction of interlobular bile ducts
A Mallat1, E S Zafrani, J M Metreau
1Service d'Hépatologie et de Gastroentérologie, Hôpital Henri Mondor, Créteil, France.
Abstract:
The antifungal drug terbinafine has infrequently been incriminated in the occurrence of acute liver injury. We report a case of prolonged cholestasis that occurred in a 75-year-old woman, following terbinafine administration. Jaundice followed by pruritus appeared after four weeks of therapy and was associated with mixed hepatocellular and cholestatic liver tests abnormalities. Following drug withdrawal, serum bilirubin returned to normal values within three months, but anicteric cholestasis persisted for over six months. A liver biopsy performed after six months showed centrilobular cholestasis, discrete portal fibrosis, and a reduction in the number of interlobular biliary ducts. Terbinafine should be added to the list of drugs that can cause reduction in interlobular bile ducts.
Insights
Terbinafine, an antifungal medication, can cause prolonged cholestasis, a liver condition. This case highlights the drug
Area of Science:
- Hepatology
- Pharmacology
- Toxicology
Background:
- Terbinafine is an antifungal agent.
- Acute liver injury is an infrequent adverse effect of terbinafine.
- Cholestasis is a condition where bile flow is reduced or blocked.
Observation:
- A 75-year-old woman developed prolonged cholestasis after terbinafine treatment.
- Symptoms included jaundice and pruritus, with mixed liver test abnormalities.
- Cholestasis persisted for over six months despite drug withdrawal.
Findings:
- Liver biopsy revealed centrilobular cholestasis, portal fibrosis, and reduced interlobular bile ducts.
- Terbinafine administration was linked to these histopathological changes.
- This suggests terbinafine can cause bile duct damage.
Implications:
- Terbinafine should be recognized as a potential cause of bile duct injury.
- Clinicians should monitor for prolonged cholestasis in patients using terbinafine.
- This case expands the understanding of terbinafine-induced hepatotoxicity.