We presented a challenging diagnosis of AMS in an adult patient with severe cholestatic hepatitis
, requiring a large number of investigations to exclude multiple differential diagnoses.
One of their patients, originally admitted with acute cholestatic hepatitis
and later diagnosed with FMF, was phenotypically similar to our patient in this case report.
Out of 100 patients, 12% of the patients had hepatic encephalopathy, 6% of the patients had symptomatic bleeding, 7% of the patients had ascites, 5% of the patients had pancreatitis, 16% of patients had cholestatic hepatitis
, 7% of patients developed AKI and one patient had transverse myelitis.
Fernandez et al., "Cholestatic hepatitis
related to use of irbesartan: a case report and a literature review of angiotensin II antagonist-associated hepatotoxicity," European Journal of Gastroenterology and Hepatology, vol.
Meizoso et al., "EpsteinBarr virus infection and acute cholestatic hepatitis
," Anales de Medicina Interna, vol.
Acute cholestatic hepatitis
associated with atorvastatin.
presents the symptoms as abnormal bile generation, secretion, and excretion that leads to the intrahepatic accumulation of bile acids (BA) and other toxic compounds with progression of liver pathology.
Histopathology has revealed cholestasis, cholangiolitis, and periductal fibrosis in few cases and acute cholestatic hepatitis
has been reported rarely [5,10].
For fatal cases, there were 3 women aged between 20 and 29 years: TB MDR with lower limb edema, lymph node TB in a pregnant woman with fulminant hepatitis, and pulmonary TB with toxic epidermal necrolysis; there were 5 men aged between 28 and 70 years: TB MDR with lower limb edema, pulmonary TB with hepatic encephalopathy, multifocal TB with cytolytic hepatitis, pulmonary TB with cholestatic hepatitis
, and TB + heart failure with fulminant hepatitis (Table 2).
Ding et al disclosed the mechanism of emodin to treat cholestatic hepatitis
via anti-inflammatory pathway (Ding et al.,2008).
HBV replication in the liver is non-cytopathic; however, fibrosing cholestatic hepatitis
, a severe and rapidly progressive form of HBV infection thought to be due to a direct cytopathic effect of the virus, has been anecdotally described in patients infected with HIV and other groups of immunosuppressed patients.
On the basis of biochemical, clinical, and instrumental parameters; criteria of drug-induced liver disorders (7); and the Naranjo adverse drug reaction probability scale (8), we diagnosed probable cholestatic hepatitis
induced by mirtazapine.