Korean J Hepatol.  2008 Mar;14(1):97-101. 10.3350/kjhep.2008.14.1.97.

A case of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis

• Yoon JY
• Min SY
• Park JY
• Hong SG
• Park SJ
• Paik SY
• Park YM

• KMID: 1073334
• DOI: http://doi.org/10.3350/kjhep.2008.14.1.97

Abstract

Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.

Keyword

Allopurinol; Cholestasis; Granulomatous hepatitis; Ductopenia

MeSH Terms

Aged
Allopurinol/*adverse effects/therapeutic use
Antimetabolites/*adverse effects/therapeutic use
Bile Duct Diseases/*chemically induced/diagnosis/pathology
Bile Ducts, Intrahepatic/*drug effects/pathology
Cholestasis/*chemically induced/diagnosis/pathology
Drug Eruptions/pathology
Granuloma/*chemically induced/pathology
Hepatitis, Toxic/*pathology
Humans
Kidney Failure, Chronic/complications/drug therapy
Male