TICLOPIDINE-INDUCED ACUTE CHOLESTATIC HEP ATITIS

History and admission findings: A 52-year-old man who had sustained a cerebellar infarct was given the platelet inhibitor ticlopidine (2 x 2 50 mg/d) to prevent further thromboses. 28 days after starting the med ication he complained of itchings, feeling unwell and diarrhoea. He ha d also noted darkened urine and faecal discoloration, Physical examina tion revealed marked jaundice and multiple scratch marks over the enti re body. Investigations: The activities in serum of alkaline phosphata se (420 U/I) and of gamma-GT (470 U/I) were markedly elevated and tota l bilirubin concentration was maximally 26.4 mg/dl. Activities of GPT (197 U/I) and GOT (44 U/I) were slightly increased. No cause was found for any extra-or intrahepatic cholestasis with or without mechanical obstruction (e. g. viral or autoimmune hepatitis). A biopsy, which sho wed centro-acinar cholestasis also suggested drug-induced liver damage . Treatment and course: Despite discontinuing ticlopidine, the signs o f cholestatic hepatitis had only disappeared 2 1/2 months after the on set of symptoms. Conclusion: Changes in the blood picture, allergic sk in reactions and gastrointestinal disorders are among the significant clinical side effects of ticlopidine. As this drug is increasingly bei ng prescribed world-wide, the possibility of toxic liver damage should be taken into account.