Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lisinopril is an angiotensin converting enzyme inhibitor (ACE-I) that has been on market for more than 25 years. ACE-I are usually well tolerated and rarely have serious or life-threatening side effects. We describe an unusual presentation of fulminant hepatic cholestasis probably secondary to lisinopril. To our knowledge, this is the second case report which shows lisinopril-induced liver injury though a cholestatic mechanism. The patient was a 59-year-old woman with type 2 diabetes, a high body mass index and hypertension, who presented with a 5-week history of jaundice and itching. She had been started on lisinopril for diabetic nephropathy 8 weeks before admission. Other causes for cholestasis had been excluded through non-invasive immunology and virology screening, an ultrasound of the liver, magnetic resonance cholangiopancreatography and a liver biopsy. The biopsy was consistent with drug-induced liver injury. Lisinopril was stopped 2 weeks before admission. The patient's hospital stay was complicated by contrast nephropathy and influenza A which were both treated appropriately. Unfortunately, the liver cholestasis did not completely resolve following withdrawal of lisinopril and the patient died after 4 months. A literature search yielded only six other reported cases of lisinopril-induced liver injury. Five cases described hepatocellular damage and one showed cholestatic injury.
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PMID:Lisinopril-Induced Liver Injury: An Unusual Presentation and Literature Review. 3266 26

Lemmel's syndrome consists of obstructive jaundice due to compression of a periampular duodenal diverticulum in the absence of choledocholithiasis or tumour. Periampular duodenal diverticula are usually incidental findings, but they can be complicated. We present two cases. The first is a 79-year-old woman with hypertension and chronic kidney disease who starts with epigastric pain. Blood tests show cholestasis and a rise in bilirubin and pancreatic enzymes. Abdominal computed tomography with contrast confirms biliary dilation, parapapillary duodenal diverticulum and acute pancreatitis. Follow-up is decided. The second case is an 80-year-old man, without previous illness, with abdominal pain, fever and jaundice. Magnetic resonance cholangiopancreatography shows a 4 cm duodenal diverticulum displacing bile and pancreatic duct. ERCP is performed with the placement of a plastic biliary stent. The etiopathogenic theories of Lemmel syndrome are chronic ampullar inflammation, Oddi sphincter dysfunction due to the diverticulum or direct compression by diverticular content. The diagnosis of Lemmel syndrome is a challenge. It can be diagnosed by imaging tests, although the gold standard for diagnosis and treatment is ERCP.
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PMID:Lemmel syndrome: an uncommon complication of periampular duodenal diverticulum. 3326 3


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