Chlorpromazine jaundice: Analysis of twenty-two cases

Abstract

1. 1. Twenty-two cases of chlorpromazine jaundice are reviewed. These follow a more uniform pattern than some previous reports indicate and are consistent with the concept that chlorpromazine jaundice represents a distinct syndrome. 2. 2. The clinical syndrome defined by these cases is characterized by a brief, prodromal episode of systemic symptoms followed by a more or less prolonged period of intrahepatic biliary tract obstruction. The prodromal symptoms commonly consist of fever, chills, pruritus, upper abdominal pain and nausea, usually occurring about two weeks after the first dose of chlorpromazine and persisting for four or five days. Jaundice may appear coincidentally but usually occurs one week after the onset of systemic symptoms. At the height of the icterus other systemic symptoms usually have disappeared and pruritus may be the only complaint. The results of the laboratory tests characteristically are those obtained in obstructive jaundice, whereas the tests for parenchymal liver damage usually remain negative. A mild or moderate eosinophilia was found in the peripheral blood in over 80 per cent of the twenty-two cases in this series. 3. 3. In none of the cases presented was there evidence of antecedent liver disease. In all cases recovery was complete without evidence of residual liver damage. 4. 4. Liver biopsy was performed in six cases, all of which showed bile stasis and periportal inflammatory cell infiltration. Eosinophils made up a large part of the periportal infiltrate in three cases. It seems likely that this finding is most common when liver biopsy is obtained early in the course. 5. 5. It is postulated that chlorpromazine jaundice is part of an allergic reaction to the drug, causing functional or mechanical biliary obstruction of the cholangioles similar to that known to occur with certain other drugs.