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A case of indometacin-induced acute hepatitis developing into chronic autoimmune hepatitis

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 172–176 (2008)Cite this article

Abstract

Background A 47-year-old woman who presented with hip pain as a result of osteoarthritis was treated with indometacin. Ten days after beginning treatment she developed jaundice and ascites. All medications were discontinued, but her symptoms continued to worsen.

Investigations Physical examination, laboratory tests and radiologic examinations, including liver chemistry tests, viral serologies, serum iron studies, ceruloplasmin and alpha-fetoprotein analyses, autoimmune serologies, ascites studies, abdominal CT, liver ultrasound and liver biopsy.

Diagnosis Severe biopsy-proven hepatitis that progressed to chronic autoimmune hepatitis.

Management Treatment with prednisone 40 mg/day was initially successful. The dose of the therapy was tapered over 18 months and then discontinued, after which time the patient's liver chemistry test results worsened. Repeat liver biopsy samples showed evidence of chronic hepatitis, and her liver chemistry test results improved when prednisone was restarted. The patient was maintained on 750 mg twice-daily mycophenolate mofetil and prednisone was decreased to 5 mg every other day.

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Figure 1: Liver biopsy results from the patient with indometacin-induced acute hepatitis (A and B) that progressed to chronic autoimmune hepatitis (C and D).

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Author information

Author notes

  1. AL Baker is a Professor of Medicine in the Division of Hepatology at Northwestern University, Chicago, IL, USA.

Authors and Affiliations

  1. C Abraham is an Assistant Professor at the Department of Internal Medicine, and at the time of writing was an Assistant Professor in the Section of Gastroenterology and Department of Medicine at The University of Chicago, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA, IL, USA.,

    Clara Abraham

  2. J Hart is a Professor in the Department of Pathology at The University of Chicago, IL, USA.,

    John Hart

  3. SM Locke practices Family Medicine at West Suburban Hospital, Chicago, IL, USA.,

    Susan M Locke & Alfred L Baker

Authors
  1. Clara Abraham
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  2. John Hart
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  3. Susan M Locke
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  4. Alfred L Baker
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Corresponding author

Correspondence to Clara Abraham.

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Competing interests

The authors declare no competing financial interests.

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Abraham, C., Hart, J., Locke, S. et al. A case of indometacin-induced acute hepatitis developing into chronic autoimmune hepatitis. Nat Rev Gastroenterol Hepatol 5, 172–176 (2008). https://doi.org/10.1038/ncpgasthep1055

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