Chronic hepatitis drug-induced

Chemical injuries to the liver depend on the type of toxic agent, the severity of intoxication, and the type of exposure, whether acute or chronic. The six basic types of liver damage are fatty liver, necrois, hepatobiliary dysfuntions, viral-hke hepatitis, and (on chronic exposure) cirrhosis and neoplasia. A number of organic chemicals and drugs induce fatty liver and hver necrosis. 

Margolin N. Severe leucocytoclastic vasculitis induced by repaglinide in a patient with chronic hepatitis C. Clin Drug Invest 2002 22 795-6. 

A biopsy is often required to make a diagnosis of most types of liver disease. A specimen of liver can be used to identify fibrosis, cirrhosis, cholestasis and hepatitis, both acute and chronic, and tumours. Biochemical measurements can also be taken from a biopsy specimen to determine iron and copper content, virology, microbiology and haematology (e.g. increased numbers of eosinophils in a drug-induced cause). The biopsy can give an indication of the extent of the liver damage. See Chapter 3 for slides of liver biopsies. 

THC 4 d) and other cannabinoids undergo extensive biotransformation in the body, yielding scores of metabolites, several of which are themselves psychoactive. They are extremely lipid-soluble and are stored in body fat from which they are slowly released. Hepatic drug metabolising enzymes are inhibited acutely but may also be induced by chronic use of crude preparations. 

Glycyrrhizin is widely used in Japan for the treatment of chronic hepatitis, but in a non-randomized trial in 24 patients who developed drug-induced hepatitis while undergoing antituberculosis chemotherapy, there was no difference in the time required for recovery between the patients who were treated with or without intravenous glycyrrhizin 40 mhday (28). 

A 44-year-old woman developed acute hepatitis while taking gatifloxacin for chronic sinusitis (23). After 5 days she developed nausea, lethargy, and abdominal pain, all of which progressed over the next few days. Liver function tests were abnormal, and the bilirubin peaked at 161 pmol/l. A percutaneous liver biopsy showed acute hepatitis with eosinophilic infiltrates, consistent with drug-induced hepatitis. 

Mild chronic drug-induced hepatitis has been attributed to tenoxicam (SEDA-21,108). 

Hepatic encephalopathy is a metabolic disorder characterized by a wide spectrum of neuropsychiatric dysfunction. It may occur as an acute syndrome in patients with acute hepatic failure from viral or drug-induced hepatitis or as a chronic syndrome associated with liver failure and cirrhosis. 

As discussed earlier, most cases of drug-induced liver disease present as acute hepatitis. Less commonly, drugs have produced a chronic liver injury, in a pattern mimicking chronic hepatitis or other chronic liver injury (chronic... 

Seeff L. Drug-induced chronic liver disease, with emphasis on chronic active hepatitis. Semin Liver Dis 1981 1 104-15. 

One side effect unique to hydralazine is a dose-dependent drug-induced lupus-like syndrome. Hydralazine is eliminated by hepatic A-acetyltransferase. This enzyme displays genetic polymorphism, and slow acetylators are especially prone to develop drug-induced lupus with hydralazine. This syndrome is more common in women and is reversible on discontinuation. Drug-induced lupus may be avoided by using less than 200 mg hydralazine daily. Other side effects of hydralazine include dermatitis, drug fever, peripheral neuropathy, hepatitis, and vascular headaches. For these reasons, hydralazine has limited usefulness in the treatment of hypertension. However, it is still used with isosorbide dinitrate in patients with heart failure (especially African-Americans) and is useful in patients with severe chronic kidney disease and kidney failure. 

Drug-induced liver disease occurs as several different clinical presentations idiosyncratic reactions, allergic hepatitis, toxic hepatitis, chronic active toxic hepatitis, toxic cirrhosis, and liver vascular disorders. 

Autoimmune hepatitis (AIH). Chronic autoimmune-mediated hepatic inflammation characterized by antinuclear (ANA), smooth muscle (SMA)/anti-F-actin, liver-kidney microsomal (LKM), and soluble liver antigen (SLA) antibodies. Autoimmune hepatitis constitutes 10-20% of all cases of chronic hepatitis, ft may be idiopathic (Alff type 1, 2, and 3), part of autoimmune polyendocrine syndrome type 1 (APECED hepatitis), or drug-induced. See also -liver-kidney microsomal antibodies, liver-specific antigens. 

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