Drug-induced acute cholestatic liver damage in a patient with mutation of UGT1A1

Background A 54-year-old woman presented with a 3-week history of fatigue and with jaundice that began 2 days before admission. She had been undergoing treatment with flavoxate for urinary incontinence (for 2 months before admission) and with tibolone for climacteric syndrome (for 6 months before admission). Laboratory tests revealed elevated concentrations of aminotransferases, bilirubin, γ-glutamyltransferase and alkaline phosphatase. Liver biopsy revealed histological evidence of subacute, drug-induced liver damage. Investigations Physical examination, liver function tests, serology tests, autoantibody tests, genetic analysis of the TATA box of the UGT1A1 gene, ultrasonography and CT scan; MRI cholangiography; liver biopsy. Diagnosis Drug-related hepatitis in a patient with Gilbert's syndrome. Management Flavoxate and tibolone were discontinued. Liver function test results improved progressively and normalized after almost 2 months.