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• W2977253010 abstract "Purpose: INTRODUCTION: Drug induced liver injury (DILI) generally causes elevations of alanine aminotransaminase (ALT) levels and obstructive hepatobiliary disease usually causes elevation of alkaline phosphates (ALP) and gamma-glutamyltransferase (GGT). We present a case of DILI with abnormal ALP & GGT levels. CASE REPORT: An 88-year-old white female with medical history significant for HTN, CAD, hyperlipidemia and breast cancer was admitted to the psychiatric ward with major depression. She had a mastectomy 5 years ago and was taking anastrozole daily; an aromatase inhibitor used as adjuvant hormonal therapy in postmenopausal women with hormone receptor-positive breast cancer. Her other medications were metoprolol, enalapril, pravastatin, aspirin, clopidogrel and alendronate. She was not on any natural or herbal supplements. Physical examination was normal except for a mastectomy scar. Laboratory testing revealed abnormal liver function tests (LFT's): total bilirubin of 1.3 mg/dl, ALP of 509 iu/l, GGT of 1578 iu/l, ALT of 167 iu/l and aspartate aminotransaminase (AST) of 159 iu/l. CBC, PT/INR, viral hepatitis panel, autoimmune antibodies (including anti-mitochondrial and anti-smooth muscle autoantibodies), tumor markers (alpha-fetoprotein, CA 19-9, CEA, CA 27-29, CA 15-3) and imaging studies (abdominal sonogram and MRI) were unremarkable. A review of her records revealed that she had normal LFT's two months prior to admission. Patient was successfully treated for her mood disorder with mirtazapine and the anastrozole was discontinued. On repeat testing the LFT's showed improvement. She was advised to follow up with her oncologist and discuss alternative treatment. DISCUSSION: In our patient obstructive, viral and autoimmune causes of hepatitis were excluded out and DILI was thought to be the most likely cause. Among the patient's medications, anastrozole & pravastatin were likely causes for DILI. While pravastatin only affects transaminases, anastrozole can cause elevations of ALT, AST, ALP and rarely GGT. DILI can present with cytolytic, cholestatic or mixed patterns. Cytolytic damage usually occurs after a brief drug exposure whereas cholestasis is idiosyncratic and can occur after a prolonged latency period. Our patient had a prolonged latency period and presented with cholestatsis. Given the latency period, we suspect that anastrozole induced the translation of greater amounts of ALP & GGT. We believe that anastrozole could therefore be a novel inducer of cholestatic liver enzymes similar to that seen with phenytoin, barbiturates, rifampin and St. John's Wort. Further studies are needed to confirm this theory. We suggest that LFT's should be closely monitored in patients on anastrozole." @default.
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• W2977253010 date "2011-10-01" @default.
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• W2977253010 title "A Case of Drug Induced Liver Injury" @default.
• W2977253010 doi "https://doi.org/10.14309/00000434-201110002-00739" @default.
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