Transient cholestasis during treatment with ajmaline, and chronic xanthomatous cholestasis after administration of ajmaline, methyltestosterone and ethinylestradiol. Two case reports.

Abstract

Abstract. Intrahepatic cholestasis and jaundice have been observed in one male and one female patient treated with ajmaline. The male patient improved rapidly upon interruption of therapy. The female who, in addition, had been given methyltestosterone and ethinylestradiol, developed a pronounced xanthomatous cholestasis that has persisted for more than two years. There has been no evidence of liver failure in this case. Galactose tolerance tests have been normal. Liver slices from the patient metabolized methyltestosterone in a similar way and to the same extent as those of a control subject. The ultrastructure of many of the liver parenchymal cells appeared normal, whereas others contained vacuoles filled with irregular clumps of electron‐dense material–“whorl bodies”–believed to represent altered, and reabsorbed, bile. Similar bodies reflecting regurgitation of bile, probably through diacytosis, were also encountered in the Kupffer cells and in the extracellular spaces (the sinusoids, the bile capillaries and intercellularly between the parenchymal cells). One year after the onset of symptoms there was no evidence of biliary cirrhosis. The observations suggest that the combined effects of several cholestatic agents may result in a more severe cholestatic disease than occurs when either of the drugs is administered alone.