We report the case of a 65-year-old patient with no previous history of liver disease, although he reported daily consumption of 65 g of alcohol, who underwent abdominal CT with intravenous contrast when an abdominal mass was suspected.
An analysis performed one week before this exploration showed a slight elevation of elevated transaminase levels probably (< 1.5 the upper limit of normal for both) with GGT more than 4 times higher than normal values for ethanol consumption.
After CT, the patient presented asthenia and darkened urine.
The physical examination revealed intense authenticity.
Analyses performed 3 days after CT showed stasis with 12.1 mg/dl (esterified 8.27), GGT 562 U/38 bilirubin (40-129).
ALT and AST values were 84 and 120 U/l (with normal limits 18 and 22 respectively).
Urgent abdominal ultrasound showed no abnormalities in the bile duct.
The liver was normal in size and had a patchy tapered appearance (findings comparable to those obtained in previous CT).
Hepatotropic virus (HAV, HBV, HCV, EBV, CMV and HSV) infection was ruled out and autoimmunity markers were negative.
Two hours after the first analysis bilirubin decreased to 2.6 mg/l with esterified 1.71.
Levels of AST, ALT, AST and alkaline phosphatase had also decreased.
Two months later, all liver biochemistry had normalized, except for GGT, which was twice as normal.
The patient continued to consume the same amount of alcohol.
1.
The close temporal relationship between the administration of contrast and the clinical picture and the application of the CIOMS scale for the evaluation of the causality of a drug in a probable hepatopathy (3), allow us to consider this case as a probable occurrence.
This case has therefore been reported to the Spanish Pharmacovigilance System.
It is possible that the presumable basal hepatic alteration of our case contributed to the damage caused by iopromide.
Unlike other special contrast agents, iopromide seems to be a safe drug from the hepatic point of view, since it has several side effects (4.5).
1.
F. Bolado Concejo, F. Capdevila Bastons1, J. M. Zozaya Urmeneta, B. González de la Hera and J. L. Garcíatena2
Digestive Appliance Services, 1 Pharmacy and 2Radiology.
Navarre Hospital.
Pamplona
