Hyperbilirubinemia induced by bosentan

Abstract

A 79-year-old female patient with a secondary pulmonary hypertension received an oral bosentan 62.5 mg twice daily. Her liver function was normal before medication. On the day 57 after begining of the medication, laboratory tests showed aspartate aminotransferase(AST) 44 U/L, alanine aminotransferase (ALT) 43 U/L, gamma glutamyl transferase (γ-GT) 166 U/L, alkaline phosphatase (ALP) 249 U/L, glutamate dehydrogenase(GDH)30.8 U/L, albumin 31.7 g/L, total bilirubin(TBil) 50.0 μmol/L, direct bilirubin(DBil) 23.8 μmol/L , and indirect bilirubin(IBil) 26.2 μmol/L. On the day 62, the patient developed yellowish discoloration of skin and sclera, fatigue and loss of appetite. Laboratory tests showed the following levels: AST 39 U/L, ALT 32 U/L, GGT 276 U/L, ALP 417 U/L, GDH 14.5 U/L, albumin 33.6 g/L, TBil 120.8 μmol/L, DBil 65.3 μmol/L, IBil 55.4 μmol/L. Drug-induced liver injury was diagnosed. Bosentan was withdrawn and hepatoprotective agents were given. Five days after the drug withdrawal, her jaundice disappeared. Thirty-three days after the drug withdrawal, laboratory tests showed AST 25 U/L, ALT 13 U/L, GGT 43 U/L, ALP 125 U/L, GDH 1.8 U/L, albumin 37 g/L, TBil 24.0 μmol/L, DBil 9.2 μmol/L, and IBil 14.8 μmol/L. Key words: Bosentan; Hyperbilirubinemia