Abstract
Intrahepatic cholestasis is manifested by an obstructive type jaundice but the exact mechanism which cause failure of bilirubin secretion because of drugs is not known. It is recognized as a benign complication of oral contraceptive agents. This paper describes the case report of 2 sisters who were using contraceptive agents where the common component was norethisterone. Both sisters were well built with auburn hair and hazel eyes. Both were 0 rhesus -positive. In each case pruritis was severe and the most unbearable symptom. It was treated successfully with intravenous ACTH and oral prednisone and the itching was relieved but the jaundice continued over many months. One sister had severe pruritis during the latter part of her 3 pregnancies. The mother of these women had no problems during her 3 pregnancies. The other sister in this family was taking Anovlar 21 which she had used for 2 years without problems. This sister presented a totally different physical appearance and is A rhesus-positive. The strong similiarity between these 2 sisters and their common reaction to this steroid causes speculation that the jaundice may be due to a genetic abnormality and possibly a single enzyme defect.
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