Document 2946
 DOCN  M94A2946
 TI    G-CSF induced hepatitis and pancreatitis in a HIV-seropositive patient.
 DT    9412
 AU    Zylberberg L; Zylberberg H; Havard S; Hagege H; Franck N; Escande JP;
       Tarnier Hospital, Paris, France.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):189 (abstract no. PB0184). Unique
       Identifier : AIDSLINE ICA10/94369629
 AB    Among the side effects induced by the granulocyte colony-stimulating
       factor (G-CSF) acute hepatitis with histological confirmation and
       biologic pancreatitis have never been reported. We report a case of 35
       years old HIV seropositive homosexual male who had no history of
       hepatobiliary disorder nor alcohol abuse. He received Disulone as a
       preventive therapy against Pneumocystosis and Adriamycin with G-CSF for
       pulmonary Kaposi sarcoma. Hepatic and pancreatic function tests were
       within normal range before the prescription of G-CSF. CD4-positive
       lymphocyte count was then 50/mm3. Cholestatic and cytolytic hepatitis
       and biological pancreatitis appeared two weeks after the beginning of
       G-CSF. All viral markers were negative, including polymerase chain
       reaction for hepatitis C virus RNA and Dot blot for hepatitis B virus
       DNA. Endoscopic retrograde cholangiopancreatography showed no
       abnormalities. A transparietal liver biopsy showed signs of acute
       cytolytic and cholestatic hepatitis, without pathogens on histological
       examination and cultures, consistent with the diagnosis of drug-induced
       hepatitis. Disulone and G-CSF were interrupted, which induced an
       improvement of hepatic and pancreatic function tests. Because of a
       suspicion of disulone induced hepatitis, G-CSF was reintroduced, which
       ledd to worsening of hepatic and pancreatic function. The definitive
       arrest of G-CSF ledd to a decrease to sub-normal values of hepatic and
       pancreatic enzymes in three weeks. The usual imputability criteria for
       liver drug toxicity tend to incriminate G-CSF in the pathogeny of this
       mixed acute hepatitis. The alteration of the pancreatic enzymes also had
       a chronological link with G-CSF. This is the first report of probable
       G-CSF induced acute hepatitis and pancreatitis. As hematological growth
       factors are now commonly prescribed in AIDS patients, monitoring of
       liver and pancreatic enzymes should be recommanded.
 DE    Adult  Biopsy  Case Report  Combined Modality Therapy  Diagnosis,
       Differential  Doxorubicin/ADMINISTRATION & DOSAGE  Granulocyte
       Colony-Stimulating Factor/ADMINISTRATION & DOSAGE/  *ADVERSE EFFECTS
       Hepatitis, Toxic/DIAGNOSIS/*ETIOLOGY  Human  HIV Seropositivity/*THERAPY
       Liver/PATHOLOGY  Lung Neoplasms/*THERAPY  Male  Pancreatitis/*CHEMICALLY
       INDUCED/DIAGNOSIS  Sarcoma, Kaposi's/*THERAPY  MEETING ABSTRACT

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