Hepatocellular toxic hepatitis and inverse dissociated cholestasis due to Sinovul® overdose. Case report

Abstract

Introduction: toxic hepatitis, whether functional or histological, result from liver damage caused by different substances foreign to the body, both natural and artificial. Although they are not as common when compared to other liver diseases, their importance lies in the severity they can be.

Objective: to present the case of a patient who suffered hepatotoxicity from Sinovul®, with dissociated cholestasis, an infrequent sign in patients with this type of hepatitis.

Case presentation: 38-year-old female patient with a medical history of viral hepatitis A at age 21. A month earlier, she self-medicated with four Sinovul® tablets (levonorgestrel and ethinyl estradiol). She presented nausea, weakness, tachycardia, and an acute liver disease. She was diagnosed with hepatocellular toxic hepatitis with inverse dissociated cholestasis, for which the overdose of the drug consumed, the chronology of the symptoms and the results of the tests were taken into account. She was indicated symptomatic treatment, and after four months the disease subsided.

Conclusions: when faced with a patient with liver failure, the specialist must carry out a detailed anamnesis to establish the correct diagnosis early. The possible toxic origin of hepatitis should always be taken into account, considering the drugs that can most frequently cause it according to the age of the patients and the signs that - despite being infrequent - are associated with the disease. The importance of the physician's adherence to the clinical method for an accurate diagnosis of the condition is underlined.