BILE DUCTOPENIA FOLLOWING THERAPY WITH SULPIRIDE

We report a case of ductopenia associated with cholestatic hepatitis i n a 59-year-old woman treated for 41 years for temporal epilepsy, The patient developed jaundice, without any clinical or biochemical featur es of hypersensitivity, 10 months after the beginning of treatment wit h sulpiride, Liver biopsy showed ballooning and acidophilic degenerati on of the hepatocytes, macrophages packed with lipofuscin, biliary pig ment in Kupffer cells, some biliary plugs, confluent necrosis and abse nce of biliary ducts in all the portal tracts. These features and the presence of foci of cholangiolitis suggest a destructive cholangitis a s the pathogenetic mechanism causing ductopenia. Other causes of ducto penia were excluded, Sulpiride is known to produce severe cholestatic jaundice, which we believe is due to ductopenia. The absence of hypers ensitivity and the 10-month latency suggest that sulpiride may cause l iver damage through a toxic mechanism in genetically susceptible subje cts.