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- W2978237356 abstract "Purpose: A 31-year-old female presented with a one week history of fever and diffuse maculopapular rash. She had a vaginal delivery of her first child 5 weeks ago and developed a seizure 10 days later. The patient was then started on phenytoin. Initial lab findings showed mild elevation of AST of 56 and ALT of 54. CT of the abdomen was performed which revealed suspicion for early appendicitis, and the patient underwent a laparascopic appendectomy. Despite surgical intervention, she continued to have high fevers up to 102.4 °F. Follow-up labs showed marked elevation of AST of 1277 and ALT of 1150, and phenytoin was discontinued. An ERCP was attempted for possible microlithiasis, however, it was complicated with desaturation and development of a seizure. She required intubation and was transferred to the ICU. The skin rash continued to worsen and a skin biopsy was performed that showed findings compatible with drug reaction. Liver biopsy was performed which revealed active hepatitis, however, no plasma cells were observed. Initial diagnosis was thought to be hepatitis secondary to phenytoin. Patient continued to remain febrile and follow-up lab showed predominant worsening of bilirubin levels. A repeat liver biopsy (Figure 1) was performed which now revealed active hepatitis with prominent infiltration of plasma cells. Serum immunoglobulin G level was checked at 4350 mg/dl. The patient was started on prednisone 60 mg daily, which resulted in rapid improvement of abnormal liver enzymes. Follow-up AST was 50, ALT was 65 in one week, and AST was 20, ALT was 16 in three weeks. Discussion: Minocycline and nitrofurantoin are the two drugs that have been reported to account for 90% of the causes of drug-induced autoimmune hepatitis. To our knowledge, this is the first case of phenytoin to cause autoimmune hepatitis to be reported in the literature. Phenytoin is associated with numerous side effects and hepatic failure have been reported in rare cases. Development of autoimmune hepatitis is a novel side effect that was first identified in this case.Figure 1: No Caption available." @default.
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- W2978237356 date "2012-10-01" @default.
- W2978237356 modified "2023-10-14" @default.
- W2978237356 title "Phenytoin-induced Autoimmune Hepatitis" @default.
- W2978237356 doi "https://doi.org/10.14309/00000434-201210001-00993" @default.
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