Abstract
We report a case of ductopenia associated with cholestatic hepatitis in a 59-year-old woman treated for 41 years for temporal epilepsy. The patient developed jaundice, without any clinical or biochemical features of hypersensitivity, 10 months after the beginning of treatment with sulpiride. Liver biopsy showed ballooning and acidophilic degeneration of the hepatocytes, macrophages packed with lipofuscin, biliary pigment in Kupffer cells, some biliary plugs, confluent necrosis and absence of biliary ducts in all the portal tracts. These features and the presence of foci of cholangiolitis suggest a destructive cholangitis as the pathogenetic mechanism causing ductopenia. Other causes of ductopenia were excluded. Sulpiride is known to produce severe cholestatic jaundice, which we believe is due to ductopenia. The absence of hypersensitivity and the 10-month latency suggest that sulpiride may cause liver damage through a toxic mechanism in genetically susceptible subjects.
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References
Cavanzo FJ, Garcia CF, Botero RC (1990) Chronic cholestasis, paucity of bile ducts, red cell aplasia, and the Stevens-Johnson Syndrome. An Ampicillin-associated case. Gastroenterology 99:854–856
Degott C, Feldmann G, Larrey D, Durand-Schneider AM, Grange D, Machayekhi JP, Moreau A, Potet F, Benhamou JP (1992) Drug-induced prolonged cholestasis in adults: a histological semiquantitative study demonstrating progressive ductopenia. Hepatology 15:244–251
Feray C, Samuel D, Thiorn V, Gigou M, Pichon F, Bismuth A, Brechot C (1992) Reinfection of liver graft by hepatitis C virus after liver transplantation. J Clin Invest 89:1361–1365
Hartleb M, Nowak A (1990) Severe jaundice with destructive cholangitis after administration of Methyltestosterone. Am J Gastroenterol 85:766–767
Horsmans Y, Rahier J, Geubel AP (1991) Reversible cholestasis with bile duct injury following azathioprine therapy. A case report. Liver 11:89–93
Ishii M, Miyazaki Y, Yamamoto T, Miura M, Ueno Y, Takahashi T, Toyota T (1993) A case of drug induced ductopenia resulting in fatal biliary cirrhosis. Liver 13:227–231
Larrey D, Erlinger S (1988) Drug induced cholestasis. Bailliere's Clin Gastroenterol 2:423–452
Larrey D, Pessayre D, Duhamel G, Casier A, Degott C, Feldmann G, Erlinger S, Benhamou JP (1986) Prolonged cholestasis after aymaline-induced acute hepatitis. J Hepatol 2:81–87
Larrey D, Amouyal G, Pessayre D, Degott C, Danne O, Machayekhi JP, Feldmann G, Benhamou JP (1988) Amitriptyline induced prolonged cholestasis. Gastroenterology 94:200–203
Ludwig J, Wiesner RH, La Russo NF (1988) Idiopathic adulthood ductopenia. A cause of chronic cholestatic liver disease and biliary cirrhosis. J Hepatol 7:193–199
Manivel JC, Bloomer JR, Snover DC (1987) Progressive bile duct injury after Thiabendazole administration. Gastroenterology 93:245–249
Melzer E, Knobel B (1987) Severe cholestatic jaundice due to sulpiride. Isr J Med Sci 23:1259–1260
Mogens, Vyberg (1993) The hepatitis associated bile duct lesion. Liver 13:289–301
Mullick FG, Ishak KG (1980) Hepatic injury associated with diphenylhydantoin therapy. Am J Clin Pathol 74:442–451
Parker WA, Shearer CA (1979) Phenytoin hepatotoxicity: a case report and review. Neurology 29:175–178
Sherlock S (1987) The syndrome of disappearing intrahepatic bile duct. Lancet I:493–496
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Villari, D., Spinella, S., Rubino, F. et al. Bile ductopenia following therapy with sulpiride. Vichows Archiv A Pathol Anat 427, 223–226 (1995). https://doi.org/10.1007/BF00196529
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DOI: https://doi.org/10.1007/BF00196529