Document 0345
 DOCN  M9650345
 TI    Subacute mitochondrial liver disease in a patient with AIDS: possible
       relationship to prolonged fluconazole administration.
 DT    9605
 AU    Guillaume MP; De Prez C; Cogan E; Department of Internal Medicine,
       Hopital Universitaire Brugmann,; Belgium.
 SO    Am J Gastroenterol. 1996 Jan;91(1):165-8. Unique Identifier : AIDSLINE
       MED/96145309
 AB    Azole-derived antifungal medications are particularly involved in
       drug-induced hepatic injury encountered in patients with AIDS.
       Fluconazole may induce multiple hepatic abnormalities usually
       characterized by asymptomatic and reversible mild hepatic necrosis. We
       here describe severe subacute liver damage occurring in a patient with
       AIDS who was receiving fluconazole maintenance therapy for a
       cryptococcosis. Hepatotoxicity was essentially characterized by mixed
       cytolytic and cholestatic liver tests abnormalities which improved after
       fluconazole discontinuation and worsened on fluconazole rechallenge.
       Optical microscopy demonstrated nonspecific abnormalities including
       granular aspect of the cytoplasm of the hepatocytes. In contrast,
       analysis of electron microscopy revealed unusual unreported features
       characterized by giant mitochondria with paracrystalline inclusions and
       enlarged smooth endoplasmic reticulum. All microscopic abnormalities
       were reversed after discontinuation of fluconazole. We suggest that
       persistent increased hepatic enzymes in HIV-infected patient taking
       fluconazole should prompt suspension of the treatment. Prospective
       studies are needed to determine whether careful monitoring of hepatic
       tests should be recommended in AIDS patients on prolonged fluconazole
       maintenance therapy.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY  Acute
       Disease  Adult  Antifungal Agents/ADMINISTRATION & DOSAGE/*ADVERSE
       EFFECTS  AIDS-Related Opportunistic Infections/COMPLICATIONS/DRUG
       THERAPY  Biopsy  Case Report  Cryptococcosis/COMPLICATIONS/DRUG THERAPY
       Female  Fluconazole/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS  Hepatitis,
       Toxic/*ETIOLOGY/PATHOLOGY  Human  *HIV-1  Lung Diseases,
       Fungal/COMPLICATIONS/DRUG THERAPY  Mitochondria, Liver/*DRUG
       EFFECTS/ULTRASTRUCTURE  Time Factors  JOURNAL ARTICLE  REVIEW  REVIEW OF
       REPORTED CASES

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