Drug Induced Hepatitis Progressing to Cirrhosis Case Presentation
![Drug Induced Hepatitis Progressing to Cirrhosis Drug Induced Hepatitis Progressing to Cirrhosis](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-1.jpg)
![Case Presentation 58 y/o retired business man, with PMH of CAD s/p CABG and Case Presentation 58 y/o retired business man, with PMH of CAD s/p CABG and](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-2.jpg)
![Medications: Atorvastatin, Metoprolol Aspirin > 4 years Ramipril since 06/2002 (6 months) Physical exam: Medications: Atorvastatin, Metoprolol Aspirin > 4 years Ramipril since 06/2002 (6 months) Physical exam:](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-3.jpg)
![Medications – Atorvastatin – Metoprolol > 4 years – Aspirin – Ramipril since 06/2002 Medications – Atorvastatin – Metoprolol > 4 years – Aspirin – Ramipril since 06/2002](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-4.jpg)
![Liver Biopsy Centrilobular necrosis, marked mixed cellular infiltration (including polymorphonuclear cells) and “Councilman” bodies Liver Biopsy Centrilobular necrosis, marked mixed cellular infiltration (including polymorphonuclear cells) and “Councilman” bodies](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-5.jpg)
![Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl) Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl)](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-6.jpg)
![Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl) Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl)](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-7.jpg)
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- Slides: 8
![Drug Induced Hepatitis Progressing to Cirrhosis Drug Induced Hepatitis Progressing to Cirrhosis](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-1.jpg)
Drug Induced Hepatitis Progressing to Cirrhosis
![Case Presentation 58 yo retired business man with PMH of CAD sp CABG and Case Presentation 58 y/o retired business man, with PMH of CAD s/p CABG and](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-2.jpg)
Case Presentation 58 y/o retired business man, with PMH of CAD s/p CABG and ventricular aneurysm repair 14 years ago, was referred b/c of abnormal liver enzymes and jaundice 10/2002 Constitutional symptoms and abnormal ALT and AST. () serologies for viral hepatitis, (-) ANA and unremarkabble US. Medicine withheld a few days 11/2002 Worsening of liver enzymes. Elevation of serum bilirubin 12/2002 Initial visit at University of Miami
![Medications Atorvastatin Metoprolol Aspirin 4 years Ramipril since 062002 6 months Physical exam Medications: Atorvastatin, Metoprolol Aspirin > 4 years Ramipril since 06/2002 (6 months) Physical exam:](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-3.jpg)
Medications: Atorvastatin, Metoprolol Aspirin > 4 years Ramipril since 06/2002 (6 months) Physical exam: (+) icteric sclera Enlarged liver with smooth border, no ascites, no splenomegaly No peripheral edema, no palmar erythema, no telangectasia No encephalopathy
![Medications Atorvastatin Metoprolol 4 years Aspirin Ramipril since 062002 Medications – Atorvastatin – Metoprolol > 4 years – Aspirin – Ramipril since 06/2002](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-4.jpg)
Medications – Atorvastatin – Metoprolol > 4 years – Aspirin – Ramipril since 06/2002 (6 months) Physical Exam – (+) icteric sclera – Enlarged liver with smooth border, no ascites, – no splenomegaly – No peripheral edema, no palmar erythema, no telangectasia – No encephalopathy
![Liver Biopsy Centrilobular necrosis marked mixed cellular infiltration including polymorphonuclear cells and Councilman bodies Liver Biopsy Centrilobular necrosis, marked mixed cellular infiltration (including polymorphonuclear cells) and “Councilman” bodies](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-5.jpg)
Liver Biopsy Centrilobular necrosis, marked mixed cellular infiltration (including polymorphonuclear cells) and “Councilman” bodies
![Ramipril Baseline Albumin gd L serum 4 1 SGOTSGP T 2016 Total bilirubin mgdl Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl)](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-6.jpg)
Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl) 0. 6 PT (INR) Ramipril (re)started ER visit Ramipril Meds d/c stopped 5 months 281/501 UDCA 6 months 7 months 8 months 3. 6 3. 4 2. 0 848/1684 1589/907 2570/1484 1. 6 19. 9 23. 2 1. 1 1. 6
![Ramipril Baseline Albumin gd L serum 4 1 SGOTSGP T 2016 Total bilirubin mgdl Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl)](https://slidetodoc.com/presentation_image_h2/5531c48c60cbb95de1e6fe5e4b02768d/image-7.jpg)
Ramipril Baseline Albumin (g/d. L) (serum) 4. 1 SGOT/SGP T 20/16 Total bilirubin (mg/dl) 0. 6 PT (INR) Ramipril (re)started ER visit Ramipril Meds d/c stopped 5 months 281/501 UDCA OLTx 6 months 7 months 8 months 9 months 3. 6 3. 4 2. 0 848/1684 1589/907 2570/1484 462/310 1. 6 19. 9 23. 2 7. 7 1. 1 1. 6 1. 4
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Explant