Sezgin VATANSEVER, Mahmut ARABUL, Mustafa ÇELİK, Fatih CANTÜRK, ALTAY KANDEMİR, Emrah ALPER, Belkıs ÜNSAL

Irbesartan-induced autoimmune hepatitis

Literatürde anjiyotensin II reseptör blokerlerinin indüklediği hepatotoksisite ile ilgili birkaç vaka rapor edilmiştir. Bu bileşikler için hepatotoksisite açısından, A sınıfı uyarı muhtemelen düşünülmelidir. Biz bir anjiyotensin- II reseptör blokörü olan irbesartan başlandıktan kısa süre sonra hepatoselüler tipte hasar gelişip, karaciğer fonksiyon testleri bozulan otoimmün hepatit vakasını rapor ettik. Serolojik, biyokimyasal ve ultrasonografi ile viral hepatit, metabolik hastalıklar ve ekstrahepatik biliyer hastalıklar dışlandı. Serolojik testlerden ANA (+) idi. Karaciğer biyopsisinde, perivenüler alanda ve özellikle kolestatik tipte akut hepatiti düşündüren sentrilobüler nekroz izlendi. Irbesartan kesildikten sonra birkaç hafta içerisinde sarılık geriledi fakat 2 ay sonra rekürrens oldu. Steroid tedavi 1 mg/kg/günden (60 mg prednisolon) başlandı. Steroid başlandıktan kısa bir süre sonra klinik ve laboratuvar iyileşme izlendi. 4 hafta içerisinde 8 mg’a azaltıldı. Hastada ilacın indüklediği otoimmün hepatit düşünüldüğünden biyopsi yapılmaksızın steroid tedavisi 1 yıl sonra kesildi.

Anahtar Kelimeler:

Yaşlı, Otoimmün hastalıklar, Kadın, Hepatit, otoimmün

Irbesartan’in indüklediği otoimmun hepatit

Several cases of angiotensin II antagonist-induced hepatotoxicity have been reported in the literature. A class warning for hepatotoxicity for these compounds should probably be considered. We report a patient who developed autoimmune-type hepatitis, whose liver function tests showed hepatocellular-type liver injury shortly after starting therapy with irbesartan, one of the angiotensin II antagonists. Serological and biochemical studies and ultrasonography ruled out viral hepatitis, metabolic diseases and extrahepatic biliary obstruction, respectively. Serologic tests for anti-nuclear antibodies were positive. In percutaneous liver biopsy, pathologic signs showed especially acute hepatitis with centrilobular necrosis in the perivenular area and also marked cholestatic features. Irbesartan was withdrawn, and the patient’s jaundice resolved slowly over a period of several weeks but recurred two months later. Steroid therapy was started, resulting in progressive improvement in symptoms and laboratory data. In this patient, steroid therapy was continued up to one year. Upon cessation of steroid therapy, there was recurrence eight months later, and steroid therapy was restarted.

Keywords:

Aged, Autoimmune Diseases, Female, Hepatitis, Autoimmune,

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