Medication-Induced Hepatitis caused by Antipsychotic Drugs as a Revelation of Wilson's disease

Abstract

Wilson's disease is an autosomal recessive genetic disorder that results from a mutation in the gene for a heavy metal transporter. This leads to a decrease or absence of copper transport in the bile and its accumulation in organs, particularly the brain. Affected patients have hepatic, neurological or psychiatric forms, and the diagnosis is based on clinical, biological, radiological and presumptive phenotypic arguments, as well as on associated molecular anomalies. Wilson's disease can result in behavioral disorders, depression, and psychosis: schizophrenia or manic depression. The diagnosis can be made if there is a combination of low ceruloplasmin, high cupremia, high cupruria, and a Kayser-Fleisher ring. In case of hemolysis, the cupremia may be elevated. On MRI, signal abnormalities of the basal ganglia, white matter and trunk are indicative of Wilson's disease. Genetic study is performed in case of family history. We present a clinical case of drug-induced hepatitis under antipsychotic drugs in the context of schizophrenia which was revealing of wilson's disease. Although rare, the onset of Wilson's disease can take the form of a late-onset adult psychosis, and is important to address in psychiatry. Is this a comorbidity of schizophrenia and wilson's disease, or is the psychiatric picture merely a consequence of neurological involvement with the disease?