Cholestasis rare causes

Serious untoward effects are rarely caused by erythromycin. Among the allergic reactions observed are fever, eosinophilia, and skin eruptions, which may occur alone or in combination each disappears shortly after therapy is stopped. Cholestatic hepatitis is the most striking side effect. It is caused primarily by erythromycin estolate and rarely by the ethylsuccinate or the stearate. The illness starts after about 10 to 20 days of treatment and is characterized initially by nausea, vomiting, and abdominal cramps. The pain often mimics that of acute cholecystitis. These symptoms are followed shortly thereafter by jaundice, which may be accompanied by fever, leukocytosis, eosinophilia, and elevated transaminases in plasma. Biopsy of the liver reveals cholestasis, periportal infiltration by neutrophils, lymphocytes, and eosinophils, and occasionally, necrosis of neighboring parenchymal cells. Findings usually resolve... 

Elevation of serum copper is found in cholestasis, obstructive jaundice, primary biliary cholangitis, malignant tumours, kwashiorkor, exocrine pancreatic insufficiency, during the last trimenon of pregnancy and after administration of oestrogens. A decrease in serum copper is typical of Wilson s disease. In some rare cases, it is caused by familial benign hypocupraemia and nutritional deficiency in neonates. 

This rare form, which is inherited via a recessive autosomal route, was described in 1968 as a variant of BRIC. (1, 2) The genetic defect is located on chromosome 15 q. A specific feature of this disease in neonates is giant-cell hepatitis with cholestasis, (s. p. 417) From about the 6 year of life until puberty, pathogenetic hypoplasia or ectasia of the lymphatic vessels with oedema are found in the lower extremities. It is not clear whether (suspected) congenital hyperplasia of lymphatic vessels in the liver is the prime cause of cholestasis. Pronounced fibrosis is often in evidence, whereas cirrhosis only occurs rarely. 

Streptococcus pneumoniae Infection with Streptococcus pneumoniae may cause both toxic liver damage and pneumococcal hepatitis with focal necroses, leading to the corresponding laboratory findings. In lobar pneumonia, jaundice (= biliary pneumonia) frequently occurs in the so-called grey hepatization stage. In addition to predominantly bacterial haemolytic jaundice, increased transaminases (20%) and cholestasis (10%) are found. The condition always regresses completely. A liver abscess induced by pneumococci is a rare event. (3-5, 9)... 

Kava extracts can, if overdosed (>60-120 mg kavapyr-ones/day) and/or taken over a longer period (>3 months), cause hepatotoxicity in the form of hepatic reactions and liver cell necrosis in rare cases, they may even cause cholestasis and acute liver failure (possibly leading to liver transplantation). Risk factors include the concomitant intake of medicaments and alcohol as well as a genetically based deficiency of cytochrome P450 2D6. (99, 116)... 

Hepatitis A is caused by a 27-nm RNA picornavirus. It has four capsid proteins (VP 1-4), but only one serotype has been identified. The virus is not cytopathic to hepatoctyes, but causes liver injury by stimulating both cellular and humoral immune responses. Hepatitis A occurs in sporadic and epidemic forms, with an incubation period of 15 to 50 days. The clinical course of acute hepatitis A is usually that of a mild fiulike iUness that lasts for a few days to a few weeks. There is no chronic form of hepatitis A, but cholestasis (manifested by several weeks of jaundice and pruritus) may occur in some adults. Although a rare occurence, relapse in up to 5% of patients has been known to happen 1 to 3 months after the acute illness. It resembles the acute illness and is associated with viremia, hut recovery always ensues. 

Intrahepatic cholestasis caused by mechanical obstruction is also common, but is rarely associated with jaundice or with visibly dilated ducts on imaging studies, although it may be associated with increased direct bilirubin. Jaundice typically occurs only with lesions that are very large, or are located near the porta hepatis, where they may obstruct both hepatic ducts. Common causes of intrahepatic obstruction include (1) tumors (particularly metastases), (2) granulomatous diseases (such as sarcoidosis and tuberculosis), and (3) infiltrative processes (such as lymphoma, leukemia, and extramedullary hematopoiesis). 

Liver Severe acute hepatitis with symptomatic cholestasis has again been attributed to atorvastatin. This is a rare adverse effect, which cause mixed hepatotoxicity and canalicular cholestasis [43 ]. In another case, that of a 68-year-old man who was taking... 

Albendazole, thiabendazole and mebendazole are also used in human medicine for the treatment of helminthiasis. Thiabendazole is frequently associated with anorexia, nausea, vomiting and dizziness at therapeutic doses. It may also cause diarrhoea, drowsiness and headache. It has resulted in erythema multiforme, hallucinations, sensory disturbances and Stevens-Johnson syndrome. Mebendazole is without significant toxicity although it may cause abdominal pain and diarrhoea. Like mebendazole, albendazole is well tolerated and only occasionally results in abdominal pain, diarrhoea, nausea, dizziness and headache. Very rarely, it may cause signs of hepatotoxicity including increases in liver enzymes, jaundice and cholestasis and it is usually recommended that its use be avoided in patients with cirrhosis. Albendazole has been reported to cause pseudomembranous colitis and dystonia in children. 

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