NDLI: Hydralazine-induced cholestatic hepatitis.

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Hydralazine-induced cholestatic hepatitis.

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Hydralazine-induced cholestatic hepatitis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Hassan, Ahad Hammad, Raza Cucco, Robert Niranjan, Selva
Description	Country affiliation: United States Author Affiliation: Hassan A ( Department of Medicine, Coney Island Hospital, Brooklyn, NY 11235, USA. drahadhassan@hotmail.com)
Abstract	Hydralazine has been widely used for treating hypertension, particularly in patients with renal failure. We report a case on a patient in whom we believe the drug was implicated in an otherwise unexplained disturbance of liver function. A 63-year-old African-American female with medical history of hypertension and end-stage renal disease (on hemodialysis) was admitted to the hospital with epigastric pain and jaundice. The symptoms started about 1 week ago. Initial laboratory tests showed abnormal liver enzymes with elevated conjugated bilirubin and alkaline phosphatase suggestive of cholestatic jaundice. Amylase and lipase were normal. Abdominal ultrasound showed normal caliber common bile duct without evidence of obstruction. Abdominal CT scan does not show any evidence of intra- or extrahepatic biliary ductal dilatation, and no mass lesions were seen in the pancreas. Further blood chemistry showed worsening of liver enzymes and increased bilirubin over the next 2-3 days. Magnetic resonance cholangiopancreatography failed to show any evidence of intra- or extrahepatic biliary ductal dilatation. No other laboratory evidence of cholestatic jaundice was found. Before proceeding for invasive diagnostic procedure, that is, endoscopic retrograde cholangiopancreatography, the patient's drug history was reviewed. She was on hydralazine 75 mg 3 times per day, started 5 months ago. At that time, her liver function tests were normal. As we could not find any other cause of cholestatic jaundice, we attributed this as a side effect of hydralazine. A trial was given by stopping the hydralazine. It was seen that there was significant improvement in the liver function enzymes over the next week. Complete clinical and biochemical recovery occurred over the next 4 weeks. Liver injury after long-term therapy with hydralazine and after short-term therapy with hydralazine (2-10 days) has been described. Hydralazine-induced hepatotoxicity may manifest as hypersensitivity-type injury, mixed hepatocellular injury, acute hepatitis, cholestatic jaundice, or centrilobular necrosis. The Hydralazine-induced cholestatic liver injury seems to be fully reversible. Complete clinical and biochemical recovery occurs after discontinuation of the drug. Also, the differential diagnosis of any patient with hepatocellular injury should include medications. This will prevent unnecessary diagnostic tests.
File Format	HTM / HTML
ISSN	10752765
Issue Number	4
Volume Number	16
e-ISSN	15363686
Journal	American Journal of Therapeutics
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2009-07-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Antihypertensive Agents Adverse Effects Drug-induced Liver Injury Etiology Cholestasis Chemically Induced Hydralazine Therapeutic Use Diagnosis, Differential Female Humans Hypertension Complications Drug Therapy Jaundice, Obstructive Kidney Failure, Chronic Middle Aged Treatment Outcome Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Pharmacology Pharmacology (medical)

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