C0601 - Rare Case of Drug-Induced Autoimmune Hepatitis

Saakshi Joshi, MD, Alexandra Davies, DO, Jaspreet Ghumman, DO
McLaren Macomb, Macomb, MI

Introduction: Our case represents rare hepatotoxic effects of Norvasq and Lipitior, more specifically Drug Induced Autoimmune Hepatitis with mixed hepatitis and cholestatic pattern and positive autoimmune hepatitis markers.

Case Description/Methods: 65 year old female, with history of hypertension, alcohol use, quit in October 2021 and sigmoid diverticulosis, presented to the office clinic with dark urine, unintentional 10lb weight loss as of 2 months ago, pale colored loose stools and new abnormal lab findings as seen in Figure 1. Patient’s abdominal ultrasound showed cholelithiasis and hepatic hemangioma. Patient’s home medications included Lipitor, which had a dose increase from 10mg to 40mg in August 2021. Additionally, the patient was started on Norvasc 5mg in August 2021. Both medications were discontinued on 12/10/2021. Patient had resolution of liver enzymes after discontinuation of medications as seen in Figure 1.

Discussion: Drug-induced autoimmune hepatitis can have a wide array of clinical presentations and therefore is included as a differential for abnormal liver biochemical tests, acute hepatitis, cirrhosis, or acute liver failure. Symptoms can range from being asymptomatic to anorexia, fatigue, abdominal pain, itching, and weight loss. Clinical studies have shown adverse hepatic function with statins, representing 0.5 to 3% of patients taking them¹. More specifically, statins do cause hepatitis in a dose-dependent manner. Rarely, there are reports of severe symptoms associated which include the hepatocellular, cholestatic and autoimmune injury. Additionally, amlodipine’s adverse drug reactions do not include hepatic injury; but post-marketing cases were reported showing amlodipine causing cholestatic hepatitis and hepatotoxicity. Similar to our case report, there was a resolution of liver enzymes after discontinuation of amlodipine.



Our case is unique as the patient had drug-induced autoimmune hepatitis with a cholestatic pattern. It is important to consider Lipitor’s dose increase as a result of hepatitis, cholestatic and autoimmune injury. Additionally, Norvasq causing cholestatic hepatitis and hepatotoxicity. This case demonstrates the rare hepatotoxic effects of amlodipine and Lipitor, further studies are needed to document the incidences.

1 Jose, Jimmy. “Statins and its hepatic effects: Newer data, implications, and changing recommendations.” Journal of pharmacy & bioallied sciences vol. 8,1 (2016): 23-8. doi:10.4103/0975-7406.171699




Disclosures:


Saakshi Joshi, MD, Alexandra Davies, DO, Jaspreet Ghumman, DO. C0601 - Rare Case of Drug-Induced Autoimmune Hepatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.