Fosinopril-induced prolonged cholestatic jaundice and pruritus: first casereport

We report a case of fosinopril-induced prolonged cholestatic jaundice and p ruritus in a 61-year-old man, with no previous hepatobiliary disease, who p resented with asthenia, jaundice and itching 3 weeks after starting fosinop ril therapy, Other drugs taken by the patient were not considered probable causes, The diagnostic evaluation showed no biliary obstruction and other p ossible causes of intra-hepatic cholestasis were excluded, Liver biopsy sho wed cholestasis without bile duct damage, The disease ran a severe course d uring the 2 months of hospitalization, with prolonged itching for 6 months, eventually controlled with oral naltrexone. Jaundice subsided after 4 mont hs, with anicteric cholestasis persisting for more than 18 months, Similar occurrences have been reported with other inhibitors of angiotensin-convert ing enzyme (mostly captopril), but this is the first case of an important a dverse reaction to fosinopril. Eur J Gastroenterol Hepatol 13:279-282 (C) 2 001 Lippincott Williams & Wilkins.