A patient was admitted with fever and jaundice. This man had recently returned from Indonesia and was still using chloroguanide 200 mg once daily for 6 weeks. Evaluation of the liver function test results was consistent with cholestatic liver disease (alkaline phosphatase 158 U/L, aspartate aminotransferase 33 U/L, alanine aminotransferase 58 U/L increasing up to 183 U/L, gamma-glutamyl transferase 96 U/L). This condition was thought to be caused by chloroguanide. A biopsy of the liver indicated drug-induced hepatitis.
To describe a case of severe hepatitis that we attribute to the use of chloroguanide.
This case shows that it is possible to develop drug-induced hepatitis with considerable morbidity while taking chloroguanide prophylaxis.
To our knowledge, this is the first report in the literature of cholestatic hepatitis associated with chloroguanide prophylaxis. In our patient, chloroguanide-induced hepatotoxicity can be considered as a combined allergic and idiosyncratic manifestation.
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