Ticlopidine-induced cholestatic hepatitis successfully treated with corticosteroids: a case report

We report a case of ticlopidine-induced cholestasis in a 62-year-old man with no previous hepatobiliary disease, who presented with jaundice and pruritus 4 weeks after starting ticlopidine therapy. Other drugs taken by the patient were not considered probable causes. The diagnostic evaluation showed no biliary obstruction and other possible causes of intra-hepatic cholestasis were excluded. The liver biopsy showed a cholestatic hepatitis with centrolobular steatosis and aggression of interlobular bile ducts. Steroid therapy was started but it was discontinued for reactivation of cytomegalovirus (CMV) infection that needed anti-viral therapy for 15 days. The disease ran a severe and protracted course, with anicteric cholestasis elevated 17 months after drug withdrawal. No rechallenge was attempted and ticlopidine was replaced with another anti-platelet drug. Cholestatic hepatitis has been reported infrequently in relation to several drugs, mainly chlorpromazine, and only once with ticlopidine. lts pathogenesis is still unknown, although some clinical findings and experimental results suggest that the drug may act through atoxic mechanism. (C) 2003 Elsevier B.V. All rights reserved.