DEXTROPROPOXYPHENE INDUCED HEPATOTOXICITY - A REPORT OF 9 CASES

Nine patients are described with jaundice, upper abdominal pain and ma laise attributable to dextropropoxyphene hepatotoxicity. In each case the history was suggestive of large bile duct obstruction. All patient s underwent ultrasound examination and percutaneous liver biopsy. Thre e patients also underwent endoscopic retrograde cholangio pancreatogra phy. The histological features of the biopsies concur with previously reported cases of dextropropoxyphene hepatotoxicity. The histological changes seen on biopsy were remarkably constant, consisting of centril obular cholistasis, portal tract inflammation and bile duct abnormalit ies, in all cases mimicking large bile duct obstruction. Fifteen previ ous patients with probable dextropropoxyphene hepatotoxicity have been described. The occurrence of 9 further cases at one centre, 6 present ing within 12 months, suggests that it is much more common than previo usly assumed and may be misdiagnosed as large bile duct obstruction.