A case of drug induced hepatitis due to warfarin potassium

Abstract

A 55-year-old man underwent a cardiac surgery requiring aortocoronary bypass on March 7 1984. For the preceeding the operation, he had not had any history of liver disease. After the surgery, warfarin potassium was prescribed. About 50 days later, he developed jaundice, and loss of appetite. The serum bilirubin level was 2mg/dl with gamma glutamyl transpeptidase of 1075 iu. and glutamic pyruvic transaminase of 1360 iu.. Serum HBsAg and IgM-anti-HA were negative. Warfarin potassium was withdrawn because drug induced hepatitis due to warfarin potassium was suspected, and over the next 4 weeks liver function tests recovered completely.
Liver biopsy showed focal liver cell necrosis with mild inflammatory infiltration. Warfarin potassium was prescribed again because of a strong demand of anti-coagulation therapy. 3 days later, he developed severe general fatigue and nausea, and there was a second rise of serum enzymes. Peripheral lymphocyte culture with warfarin potassium was positive with stimulation index of 320%. It was concluded that warfarin potassium provoked drug induced hepatitis.