aurotioprol and Chemical-and-Drug-Induced-Liver-Injury

Gold salts are still a first choice for treatment of rheumatoid arthritis. Although adverse reactions are relatively frequent, hepatic abnormalities are rare. They consist largely of reversible cholestasis, and, exceptionally, the evolution can prove rapidly fatal due to extensive hepatic necrosis. We present an additional case of this kind which occurred after a total dose of 450 mg intramuscular Aurothiopropanol over 6 weeks. The pathogenetic mechanism is complex, toxic and/or immuno-allergic. Nevertheless, regular hepatic enzyme testing is not recommended.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Chemical and Drug Induced Liver Injury; Dimercaprol; Gold; Humans; Liver; Male; Middle Aged; Necrosis; Organogold Compounds; Organometallic Compounds; Propanols; Sulfhydryl Compounds

Hepatotoxicity, predominantly cholestatic, is a rare adverse effect of gold salt therapy, which usually completely resolves within a few months. We report the case of a female patient treated for rheumatoid arthritis, who had gold salt overdose, and in whom acute cholestatic hepatitis occurred three weeks after beginning of therapy. Evolution of gold concentration was followed in plasma and urine, as well as in cutaneous and liver dry tissue. Liver biopsy showed marked inflammatory changes of interlobular bile ducts that evolved towards ductopenia, which was responsible for prolonged cholestasis still present 15 months later. In addition, sialadenitis with sicca syndrome was noted six months after onset of the disease. The mechanism of hepatotoxicity was probably immunoallergic since liver lesions were associated with hypersensitivity syndrome including dermatitis and blood and tissue eosinophilia. This is the first report of gold salt hepatotoxicity with histological demonstration of cholangitis followed by ductopenia.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Bile Duct Diseases; Biopsy; Chemical and Drug Induced Liver Injury; Cholangitis; Cholestasis, Intrahepatic; Dimercaprol; Female; Humans; Injections, Intramuscular; Liver; Middle Aged; Organogold Compounds; Organometallic Compounds; Propanols; Sulfhydryl Compounds

Topics: Adult; Arthritis, Rheumatoid; Chemical and Drug Induced Liver Injury; Dimercaprol; Drug Therapy, Combination; Gold; Humans; Indomethacin; Male; Organogold Compounds; Organometallic Compounds; Propanols; Sulfhydryl Compounds