Chlorpromazine-induced Cholestatic Liver Diseasewith Ductopenia

Overview

We describe a 30-year-old pregnant woman in whom cholestatic liver disease developed 16 resp.18 days after the medication of chlorprothixeni hydrochloridum and chlorpromazine treatment inthe 33rd week of pregnancy. Clinically, the course was characterized by severe jaundice lasting 10months, fever, pruritus, high serum alkaline phosphatase level, transient aminotransferase elevation, and hypercholesterolemia. The pregnancy was terminated in the 35th week by cesareansection with the birth of a premature female newborn without any signs of liver damage. Thehistological examination of the mother’s liver revealed ductopenia, defined by the absence ofinterlobular bile ducts in at least 50% of the small portal tracts, and long-standing cholestasiswith pseudoxanthomatous transformation of hepatocytes and ductular epithelia, and small lobuar xanthomas. The jaundice resolved very slowly after ursodeoxycholic acid therapy. The liverfunction tests 26 months after the onset of jaundice showed only a slight elevation of alkalinephosphatase and aminotransferases. In the control liver biopsy, non-active periportal and septalfibrosis without signs of cholestasis was seen. To our knowledge this is the sixth report to document chlorpromazine-induced ductopenia in pregnancy and the first to describe a newborn without any liver damage.

Key words:
chlorpromazine liver toxicity -⁠ paucity of intrahepatic bile ducts -⁠ intrahepatic choles-tasis -⁠ liver fibrosis