PROPYLTHIOURACIL-INDUCED SEVERE HEPATITIS - A CASE-REPORT AND REVIEW OF THE LITERATURE

A 21-year-old woman was diagnosed as having Graves' disease in April, 1995. Thiamazole was administered; about a month later the patient had a skin rash and propylthiouracil (PTU) was given instead. Two months after commencing PTU, she rapidly developed jaundice, accompanied by s evere liver damage. The drug-induced lymphocyte stimulating test was p ositive for PTU and she was diagnosed as having severe hepatitis induc ed by PTU. After pulse therapy with 500 mg of methylprednisolone was g iven for 3 days, liver function test results were gradually improved, and became normalized 1 1/2 months after admission. The pathology find ings of the liver biopsy sample taken before administration of cortico steroid showed necrosis of hepatocytes predominantly around the centra l veins (i.e., zone 3 necrosis), and moderate to severe infiltration o f lymphocytes and neutrophils in portal areas and lobules. Severe hepa tic damage due to PTU is rare; 25 cases have been reported so far in t he English-language literature. When we use PTU for patients with hype rthyroidism? we should keep in mind that severe liver damage induced b y PTU can be fatal, and we should therefore diagnose it earlier by liv er biopsy and lymphocyte stimulating test.