Acute hepatitis induced by cyproterone acetate

OBJECTIVE: To report a case of acute hepatitis resulting from the use of cy proterone acetate, an adjuvant treatment for prostate cancer. CASE SUMMARY: An 87-year-old white man, admitted to surgery for prostate ca ncer, received cyproterone acetate 300 mg/d orally and developed acute hepa titis, which initially was diagnosed clinically. A liver biopsy showed chan ges suggestive of acute cholestatic hepatitis. Cyproterone was stopped imme diately, and the patient was subsequently treated with corticosteroids. He then improved rapidly. DISCUSSION: Cyproterone acetate is thought to be well tolerated, but some a uthors have reported severe hepatic reactions, in particular acute hepatiti s, fatal fulminant hepatic failure, and hepatocellular carcinoma. The above -mentioned hepatotoxicity represents an idiosyncratic drug reaction, probab ly due to the hepatomitogen action of cyproterone, causing an increase of h epatocytes expressing placental glutathione S-transferase, which are consid ered preneoplastic elements. CONCLUSIONS. This case suggests the possibility of hepatotoxicity from cypr oterone.