Abstract

CHOLESTATIC DRUG INDUCED LIVER INJURY AND ALLERGIC REACTION FROM VALPROIC ACID

Pranvera Kristani*, Floreta Kurti, Eda Harizi and Adriana Babameto

Abstract

Background: Drugs are an important reason of hepatotoxicity. In general, more than 1000 drugs, toxins and herbs have been reported to cause hepatotoxicity. Acute hepatitis with or without cholestasis is the usual histological pattern of DILI (drug–induced liver injury).[2,3] Most cases of DILI resolve on discontinuation of the drug.[1] Drugs may cause liver diseases by different mechanisms.[6] DILI is a potential complication, because of the central role of the liver in drug metabolism and elimination.[9] Generally, hepatotoxicity caused by drugs is known to be: type A dose dependent (intrinsic toxicity) or type B idiosyncratic. It can be accompanied with immunologic features such as eosinophilia, rash, antibody titer.[8] Aim: To report a case of valproic acid (VPA) induced hepatotoxicity and to discuss the incidence rates, risk factors, possible etiologies, preventive measures, and treatment for this severe reaction. Case Report: A 62 years old male patient presented to the emergency department in an altered condition, confused with severe jaundice without transaminase elevation, itching and cutaneous rash. He was treated with antihypertensive drugs (irbesartan) and valproic acid for two years for epilepsy. He denied any drug reactions before. The ultrasound and CT scan of the liver was normal, also there was no viral hepatitis (B or C). Other cholestatic diseases were excluded. He was treated successfully with UDCA and cortisone in high doses. Conclusion: The exact mechanism of VPA–associated hepatotoxicity has not been clearly established.[12] Major risk factors include age, sex and concomitant treatment with more than one anticonvulsive. Older age is a determinant factor for cholestatic DILI with male predominance, whereas younger age is associated with cytolytic damage and female predominance.

Keywords: DILI, hepatotoxicity, VPA, allergic reaction.