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1994-10-25
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Document 2946
DOCN M94A2946
TI G-CSF induced hepatitis and pancreatitis in a HIV-seropositive patient.
DT 9412
AU Zylberberg L; Zylberberg H; Havard S; Hagege H; Franck N; Escande JP;
Tarnier Hospital, Paris, France.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):189 (abstract no. PB0184). Unique
Identifier : AIDSLINE ICA10/94369629
AB Among the side effects induced by the granulocyte colony-stimulating
factor (G-CSF) acute hepatitis with histological confirmation and
biologic pancreatitis have never been reported. We report a case of 35
years old HIV seropositive homosexual male who had no history of
hepatobiliary disorder nor alcohol abuse. He received Disulone as a
preventive therapy against Pneumocystosis and Adriamycin with G-CSF for
pulmonary Kaposi sarcoma. Hepatic and pancreatic function tests were
within normal range before the prescription of G-CSF. CD4-positive
lymphocyte count was then 50/mm3. Cholestatic and cytolytic hepatitis
and biological pancreatitis appeared two weeks after the beginning of
G-CSF. All viral markers were negative, including polymerase chain
reaction for hepatitis C virus RNA and Dot blot for hepatitis B virus
DNA. Endoscopic retrograde cholangiopancreatography showed no
abnormalities. A transparietal liver biopsy showed signs of acute
cytolytic and cholestatic hepatitis, without pathogens on histological
examination and cultures, consistent with the diagnosis of drug-induced
hepatitis. Disulone and G-CSF were interrupted, which induced an
improvement of hepatic and pancreatic function tests. Because of a
suspicion of disulone induced hepatitis, G-CSF was reintroduced, which
ledd to worsening of hepatic and pancreatic function. The definitive
arrest of G-CSF ledd to a decrease to sub-normal values of hepatic and
pancreatic enzymes in three weeks. The usual imputability criteria for
liver drug toxicity tend to incriminate G-CSF in the pathogeny of this
mixed acute hepatitis. The alteration of the pancreatic enzymes also had
a chronological link with G-CSF. This is the first report of probable
G-CSF induced acute hepatitis and pancreatitis. As hematological growth
factors are now commonly prescribed in AIDS patients, monitoring of
liver and pancreatic enzymes should be recommanded.
DE Adult Biopsy Case Report Combined Modality Therapy Diagnosis,
Differential Doxorubicin/ADMINISTRATION & DOSAGE Granulocyte
Colony-Stimulating Factor/ADMINISTRATION & DOSAGE/ *ADVERSE EFFECTS
Hepatitis, Toxic/DIAGNOSIS/*ETIOLOGY Human HIV Seropositivity/*THERAPY
Liver/PATHOLOGY Lung Neoplasms/*THERAPY Male Pancreatitis/*CHEMICALLY
INDUCED/DIAGNOSIS Sarcoma, Kaposi's/*THERAPY MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).