Histologic changes resembling acute rejection in a liver transplant patient treated with terbinafine

We present a case of histologic changes resembling acute cellular rejection in a liver transplant patient treated with terbinafine. Approximately 5 years after orthotopic liver transplantation, a 51-year-old Hispanic man developed elevated liver enzyme levels. A biopsy sample was interpreted as acut...

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Bibliographic Details
Published in:Human pathology 2003-02, Vol.34 (2), p.187-189
Main Authors: Lovell, Michael O., Speeg, Kermit V., Havranek, Russell D., Sharkey, Francis E.
Format: Article
Language:English
Subjects:
acute rejection
Antifungal Agents - adverse effects
Bile Ducts - pathology
Biological and medical sciences
Biopsy
Cholestasis - chemically induced
Cholestasis - pathology
Diagnosis, Differential
Drug toxicity and drugs side effects treatment
Graft Rejection - pathology
Humans
Liver - pathology
liver transplantation
Liver Transplantation - pathology
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Middle Aged
Naphthalenes - adverse effects
Pharmacology. Drug treatments
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
terbinafine
Toxicity: digestive system
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Summary:We present a case of histologic changes resembling acute cellular rejection in a liver transplant patient treated with terbinafine. Approximately 5 years after orthotopic liver transplantation, a 51-year-old Hispanic man developed elevated liver enzyme levels. A biopsy sample was interpreted as acute cellular rejection, and the patient was treated with increased immunosuppression. Review of medications showed that the patient had been started on terbinafine approximately 4 weeks earlier for onychomycosis, and it was discontinued. A follow-up visit 2 weeks later revealed progressive jaundice, malaise, and nausea, and evaluation of a second liver biopsy sample revealed marked centrilobular cholestasis and severe bile duct damage, consistent with terbinafine hepatotoxicity. Although these histologic changes have been described in treated patients with both normal and abnormal livers, the potential for confusion with acute rejection in patients with hepatic transplantation has not previously been reported. HUM PATHOL 34:187-189. Copyright 2003, Elsevier Science (USA). All rights reserved.
ISSN:0046-8177
1532-8392
DOI:10.1053/hupa.2003.16