ACUTE TOXIC HEPATITIS DUE TO ENALAPRIL (R ENITEN(R))

A 52-year-old female was hospitalized with malaise, pruritus, jaundice , abdominal discomfort and vomiting. For 20 weeks she had been taking enalapril (Reniten(R)) for hypertension. Serum aminotransferases and b ilirubin were highly elevated with prolonged thromboplastin time. Ther e was no evidence for extrahepatic cholestasis in ultrasonography. Ser ological investigations for a viral etiology of the liver failure were negative and the patient had no risk factors for viral hepatitis or e xposure to hepatotoxic substances. Liver puncture revealed hepatitis o f the fulminant viral hepatitis type, a picture that can be seen in a drug-induced hepatitis. The complete recovery of liver function after cessation of enalapril administration suggests acute toxic hepatitis d ue to enalapril. A metabolically mediated idiosyncratic reaction is th e most plausible. Potential mechanisms of enalapril-induced hepatotoxi city are discussed and the current literature is surveyed.