Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case

Detalhes bibliográficos
Autor(a) principal: Rua,João
Data de Publicação: 2019
Outros Autores: Prata,Ana Rita, Marques,Ricardo, Silva,Rafael, Gomes,Bráulio, Fraga,João, Fortuna,Jorge
Tipo de documento: Relatório
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452019000300007
Resumo: Introduction: Drug-induced liver injury is an increasingly prevalent consequence of the diversification of available therapeutic weapons, mostly idiosyncratic and with several possible mechanisms and patterns of specific damage for each drug. Carvedilol, a widely used non-selective alpha and beta blocker leads, in very rare cases, to injury of the bile ducts by toxic metabolites, resulting in a mixed-pattern hepatitis with possible progression to chronic cholestatic syndrome and cirrhosis. The authors report the second known case of this important toxicity. Clinical Case: An 83-year-old woman was admitted to the Internal Medicine ward for etiological clarification of a mixed-pattern hepatitis. Clinical history was unremarkable and structural, infectious, and autoimmune causes were excluded by blood tests and imaging exams, ultimately leading to the diagnosis of toxic hepatitis that was further confirmed by liver biopsy with morphologic findings of mixed-pattern liver injury. Carvedilol, started 6 months before, was deemed the causal agent since it was the only drug with a clinically, temporally, analytically, and histologically compatible pattern. The withdrawal of the drug resulted in slow reversal of the referred abnormalities. Conclusion: In very rare cases, carvedilol can cause important liver toxicity as a chronic cholestatic syndrome which can evolve to cirrhosis. It should be taken in consideration as causal agent in similar cases and stopped immediately upon suspicion, as the timely withdrawal results in reversion of the pathological findings.
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spelling Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical CaseCarvedilolToxic hepatitisMixed-pattern hepatitisCarvedilol-induced hepatotoxicityChronic cholestatic diseaseIntroduction: Drug-induced liver injury is an increasingly prevalent consequence of the diversification of available therapeutic weapons, mostly idiosyncratic and with several possible mechanisms and patterns of specific damage for each drug. Carvedilol, a widely used non-selective alpha and beta blocker leads, in very rare cases, to injury of the bile ducts by toxic metabolites, resulting in a mixed-pattern hepatitis with possible progression to chronic cholestatic syndrome and cirrhosis. The authors report the second known case of this important toxicity. Clinical Case: An 83-year-old woman was admitted to the Internal Medicine ward for etiological clarification of a mixed-pattern hepatitis. Clinical history was unremarkable and structural, infectious, and autoimmune causes were excluded by blood tests and imaging exams, ultimately leading to the diagnosis of toxic hepatitis that was further confirmed by liver biopsy with morphologic findings of mixed-pattern liver injury. Carvedilol, started 6 months before, was deemed the causal agent since it was the only drug with a clinically, temporally, analytically, and histologically compatible pattern. The withdrawal of the drug resulted in slow reversal of the referred abnormalities. Conclusion: In very rare cases, carvedilol can cause important liver toxicity as a chronic cholestatic syndrome which can evolve to cirrhosis. It should be taken in consideration as causal agent in similar cases and stopped immediately upon suspicion, as the timely withdrawal results in reversion of the pathological findings.Sociedade Portuguesa de Gastrenterologia2019-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/reporttext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452019000300007GE-Portuguese Journal of Gastroenterology v.26 n.3 2019reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452019000300007Rua,JoãoPrata,Ana RitaMarques,RicardoSilva,RafaelGomes,BráulioFraga,JoãoFortuna,Jorgeinfo:eu-repo/semantics/openAccess2024-02-06T17:33:57Zoai:scielo:S2341-45452019000300007Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:36:07.525910Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
title Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
spellingShingle Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
Rua,João
Carvedilol
Toxic hepatitis
Mixed-pattern hepatitis
Carvedilol-induced hepatotoxicity
Chronic cholestatic disease
title_short Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
title_full Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
title_fullStr Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
title_full_unstemmed Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
title_sort Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case
author Rua,João
author_facet Rua,João
Prata,Ana Rita
Marques,Ricardo
Silva,Rafael
Gomes,Bráulio
Fraga,João
Fortuna,Jorge
author_role author
author2 Prata,Ana Rita
Marques,Ricardo
Silva,Rafael
Gomes,Bráulio
Fraga,João
Fortuna,Jorge
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv Rua,João
Prata,Ana Rita
Marques,Ricardo
Silva,Rafael
Gomes,Bráulio
Fraga,João
Fortuna,Jorge
dc.subject.por.fl_str_mv Carvedilol
Toxic hepatitis
Mixed-pattern hepatitis
Carvedilol-induced hepatotoxicity
Chronic cholestatic disease
topic Carvedilol
Toxic hepatitis
Mixed-pattern hepatitis
Carvedilol-induced hepatotoxicity
Chronic cholestatic disease
description Introduction: Drug-induced liver injury is an increasingly prevalent consequence of the diversification of available therapeutic weapons, mostly idiosyncratic and with several possible mechanisms and patterns of specific damage for each drug. Carvedilol, a widely used non-selective alpha and beta blocker leads, in very rare cases, to injury of the bile ducts by toxic metabolites, resulting in a mixed-pattern hepatitis with possible progression to chronic cholestatic syndrome and cirrhosis. The authors report the second known case of this important toxicity. Clinical Case: An 83-year-old woman was admitted to the Internal Medicine ward for etiological clarification of a mixed-pattern hepatitis. Clinical history was unremarkable and structural, infectious, and autoimmune causes were excluded by blood tests and imaging exams, ultimately leading to the diagnosis of toxic hepatitis that was further confirmed by liver biopsy with morphologic findings of mixed-pattern liver injury. Carvedilol, started 6 months before, was deemed the causal agent since it was the only drug with a clinically, temporally, analytically, and histologically compatible pattern. The withdrawal of the drug resulted in slow reversal of the referred abnormalities. Conclusion: In very rare cases, carvedilol can cause important liver toxicity as a chronic cholestatic syndrome which can evolve to cirrhosis. It should be taken in consideration as causal agent in similar cases and stopped immediately upon suspicion, as the timely withdrawal results in reversion of the pathological findings.
publishDate 2019
dc.date.none.fl_str_mv 2019-06-01
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Gastrenterologia
publisher.none.fl_str_mv Sociedade Portuguesa de Gastrenterologia
dc.source.none.fl_str_mv GE-Portuguese Journal of Gastroenterology v.26 n.3 2019
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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