Anastrozole
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Drug-induced liver injury in the form of chronic hepatitis and periportal fibrosis: case report A 58-year-old woman developed drug-induced liver injury in the form of chronic hepatitis and periportal fibrosis during treatment with anastrozole for breast cancer. The woman, who was diagnosed with breast cancer, underwent lumpectomy and radiation therapy. Additionally, she started receiving treatment with anastrozole [route and dosage not stated]. At baseline, her liver tests (LTs) were normal. After 4 years of the initiation of anastrozole therapy, her liver enzymes were found to be elevated; however, she was asymptomatic and had not reported any symptoms or acute illness. Additionally, she did not have risk factors for chronic liver disease. She had been receiving unspecified probiotics; however, despite the discontinuation of probiotics, LTs progressively increased in the next 3 weeks. On presentation, her liver enzymes were found to be elevated. A chronic hepatitis with mild periportal fibrosis (stage II, grade II) were noted on liver biopsy. Scattered foci of necrosis were also observed. On imaging, gallbladder or bile duct pathology were ruled out. Other differential diagnosis including primary biliary cholangitis, autoimmune hepatitis and infectious/viral hepatitis were subsequently ruled out upon further work-up. Biopsy finding confirmed anastrozole-induced hepatitis. The woman’s therapy with anastrozole was stopped, which resulted in the improvement of hepatitis. She was managed on an outpatient basis despite her deranged LTs; however, her vital signs and other investigation findings were unremarkable. She received treatment with prednisone and was regularly followed-up for liver function tests. Over the next few weeks, her LTs remarkably improved, which normalised over the following 7 weeks. Her prednisone therapy was tapered off and completely discontinued 6 weeks after the diagnosis. On follow-up, she was asymptomatic, and her liver enzymes remained at the baseline. Author comment: "She scored 4 on the updated Roussel Uclaf Causality Assessment Method (RUCAM) grading system which suggested a possible drug-induced liver injury." Xie C, et al. Anastrozole-induced liver injury after a prolonged latency: A very rare complication of a commonly prescribed medication. BMJ Case Reports 12: No. 11, 2019. Available from: URL: http://doi.org/10.1136/bcr-2019-231741 803443486 USA
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Editorial comment: Details of this case report have previously been published [see Reactions 1693 p46; 803305058].
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Reactions 4 Jan 2020 No. 1785
