Danazol induced acute icteric cholestatic hepatitis

Abstract

SUMMARY
Though asymptomatic elevation of aminotransferases is not
infrequently caused by danazol, clinical evidence of liver
disease is extremely rare. The spectrum of hepatic involvement
is broad, including entities such as pure cholestasis,
cholestatic hepatitis, cytolytic hepatitis, peliosis hepatis
hepatic adenoma and hepatocellular carcinoma. We describe
the case of a male patient who was treated with
danazol for idiopathic thrombocytopenic purpura and
presented with jaundice, pruritus and discolouration of
urine and faeces five months after therapy started. Percutaneous
liver biopsy disclosed acute cholestasis and concurrent
mild hepatocellular damage. Other common causes
of cholestasis were ruled out. On danazol withdrawal he
improved clinically and bilirubin levels returned to normal
after sixteen weeks. This is the fourth case in the world literature
of danazol associated with acute icteric cholestatic
hepatitis. As this clinical spectrum can mimic the constellation
of symptoms and signs due to obstructive jaundice,
bearing the aforementioned association in mind helps to
avoid unnecessary investigations.
Keywords: danazol, hepatitis, cholestasis, drug induced liver
disease.