A case of liver damage caused by oral contraceptive agent (Anovlar)

• Published in: Kanzo Vol. 18; no. 4; pp. 281 - 287
• Main Authors: SASAKI, Ryohmi, ARAKAWA, Yasuyuki, KATSUHARA, Tokumichi, KUWANA, Hitoshi, ITOH, Arata, ABE, Masanao, HASE, Masaru, YASUHIRO, Noriaki, JINNO, Daijoh, NISHIOKA, Shinya
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Hepatology 1977
• Subjects: Anavlar
• ISSN: 0451-4203; 1881-3593
• DOI: 10.2957/kanzo.18.281

A 34-year-old woman had pruritus and severe jaundice during the first cycle of treatment with Anovlar, a mixture of 4mg norethinsterone acetate as the progestogen and 0.05mg ethinvloestradiol as the estrogen. She had no history of exposure to other hepatotoxic agents and recurrent jaundice of pregnancy. The laboratory data included a elevated level of serum bilirubin and a slight increase of alkaline phosphatase activity. But other liver-function tests were normal except for BSP excretion. Drip intravenous cholangiography revealed no extrahepatic biliary obstruction. The clinical and biochemical findings suggested intrahepatic cholestatic jaundice, which disappeared within sixty days after withdrawal of the drug. A liver biopsy specimen showed intracellular bile stasis in the centrilobular zone and also bile thrombi in the dilated bile canaliculi. There were a scanty portal inflammation and the absence of proliferation of bile ducts and fibroblasts. The lymphoblastic transformation test to Anovlar was negative (below 5%). This suggests that Anovlar may exert a hepatotoxic effect.