Pathological findings in jaundice associated with iproniazid therapy.

Abstract

Specimens of liver tissue were studied in 27 patients who had developed jaundice after taking iproniazid in amounts that totaled from 600 to 19,200 mg. over treatment periods ranging from 4 to 126 days. The aim was to define the type of hepatocellular damage associated with the jaundice and to account for the evident lack of relation between the dose of iproniazid and the severity of the hepatic lesions. The biopsy specimens showed severe spotty necrotic hepatitis with or without extensive necrosis: the 16 autopsy specimens showed either acute massive and submissive necrotic hepatitis or subacute hepatitis with massive and submassive collapse. Clinically, the findings were those of diffuse parenchymal liver disease, mostly without fever, commonly with hepatomegaly, and with terminal hepatic coma in the fatal cases. Results of conventional laboratory tests are tabulated. In some cases the jaundice appeared as late as 20 days after the cessation of therapy. Either the iproniazid activated existing subclinical viral hepatitis or else it was able to produce morphologic changes closely resembling those of viral hepatitis. In either case the possibility of inducing an insidious form of liver disease with high mortality should be kept in mind whenever the administration of iproniazid is found necessary.