A case of drug-induced liver injury with destructive cholangitis and hepatic granuloma

Abstract

A case of drug-induced hepatitis by chlorpromazine and aldomet was reported. A 71 year-old woman was admitted because of her abnormal liver function tests after taking chlorpromazine for 18 months and aldomet for a month. After withdrawal of both drugs, serum transaminases rapidly normalized and biliary enzymes gradually lowered. Liver biopsy specimen showed findings of nonspecific reactive hepatitis without cholestasis. And we found infiltrate of inflammatory cells with marked destruction of intrahepatic bile ducts in a few portal tracts, and a epithelioid cell granuloma and a lymphoid follicle in same portal area. The histological findings were reminiscent of primary biliary cirrhosis (PBC), however we found differences from PBC that this case showed tissue eosinophilia and scanty infiltrate of plasma cells in the portal tracts and no decrease of the number of intrahepatic bile ducts. Lymphocyte stimulation test was positive to both chlorpromazine and aldomet. Therefore histological pleomorphism in this case seemed to result from allergic hepatitis induced by both two drugs, chlorpromazine and aldomet.