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Drug-induced acute cholestatic liver damage in a patient with mutation of UGT1A1

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 403–408 (2007)Cite this article

Abstract

Background A 54-year-old woman presented with a 3-week history of fatigue and with jaundice that began 2 days before admission. She had been undergoing treatment with flavoxate for urinary incontinence (for 2 months before admission) and with tibolone for climacteric syndrome (for 6 months before admission). Laboratory tests revealed elevated concentrations of aminotransferases, bilirubin, γ-glutamyltransferase and alkaline phosphatase. Liver biopsy revealed histological evidence of subacute, drug-induced liver damage.

Investigations Physical examination, liver function tests, serology tests, autoantibody tests, genetic analysis of the TATA box of the UGT1A1 gene, ultrasonography and CT scan; MRI cholangiography; liver biopsy.

Diagnosis Drug-related hepatitis in a patient with Gilbert's syndrome.

Management Flavoxate and tibolone were discontinued. Liver function test results improved progressively and normalized after almost 2 months.

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Figure 1: Histologic image from the liver biopsy of a 54-year-old patient with drug-related hepatitis and Gilbert's syndrome
Figure 2: Factors influencing differential diagnoses of drug-related hepatitis in individuals with elevated levels of aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase and bilirubin (both conjugated and unconjugated)

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Author information

Authors and Affiliations

  1. I Rigato is a Consultant in the Emergency Department, San Vito al Tagliamento Hospital Pordenone, and Senior Investigator at the Liver Research Center, Trieste, Italy.,

    Igino Rigato

  2. M Cravatari is a Consultant in the Emergency Department, University Hospital of Cattinara, Trieste.,

    Monica Cravatari

  3. C Avellini is a Consultant in the Pathology Department, University Hospital of Udine, Italy.,

    Claudio Avellini

  4. E Ponte is an Associate Professor of Cardiology and an Associate Professor of History of Medicine at the University of Trieste and Senior Consultant at Internal Medicine Department, University Hospital of Cattinara.,

    Euro Ponte

  5. SL Crocè is an Assistant Professor of Medicine and Biochemistry, University of Trieste and Consultant at the Clinical Liver Research Center, University Hospital of Cattinara.,

    Saveria Lory Crocè

  6. C Tiribelli is Professor of Clinical Biochemistry, University of Trieste, Director of the Clinical Liver Research Center, University Hospital of Cattinara and Director of the Liver Research Center, Trieste.,

    Claudio Tiribelli

Authors
  1. Igino Rigato
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  2. Monica Cravatari
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  3. Claudio Avellini
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  4. Euro Ponte
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  5. Saveria Lory Crocè
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  6. Claudio Tiribelli
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Corresponding author

Correspondence to Igino Rigato.

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The authors declare no competing financial interests.

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Rigato, I., Cravatari, M., Avellini, C. et al. Drug-induced acute cholestatic liver damage in a patient with mutation of UGT1A1. Nat Rev Gastroenterol Hepatol 4, 403–408 (2007). https://doi.org/10.1038/ncpgasthep0871

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  • DOI: https://doi.org/10.1038/ncpgasthep0871

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