CHOLESTATIC HEPATITIS INDUCED BY TRIMETHO PRIM PLUS SULFAMETHOXAZOLE - CLINICAL AND IMMUNOLOGICAL EVIDENCE OF ON ALLERGIC GENESIS

History and clinical findings: A 22-year-old woman was given trimethop rim plus sulphamethoxazole for a urinary infection (160 and 800 mg, re spectively, daily), drugs she had not previously taken. After 2 weeks she noticed a rash of small spots on her trunk. In addition she had na usea and vomiting. The rash faded within 2 days of stopping the drug, but progressive jaundice developed. Investigations: SGPT and SGOT conc entrations rose to maximally 328 and 83 U/l, total bilirubin to maxima lly 5.9 mg/dl. There was no evidence for viral hepatitis (B or C, cyto megalovirus, Epstein-Barr), autoimmune hepatitis or primary biliary he patitis. Liver biopsy showed central acinar cholestasis, which suggest ed drug-induced liver damage. Course: The patient's symptoms regressed over several weeks without any specific treatment and 8 weeks after o nset of the rash the laboratory tests also became normal. The allergic cause of the cholestatic hepatitis was confirmed by a lymphocyte tran sformation test. Conclusion: Clinical suspicion of drug allergy as cau se of a cholestatic hepatitis can be confirmed reliably and without an y risk to the patient with the lymphocyte transformation test.