Text F. Hepatic Damage due to Chemotherapy

1. A 50-year old woman had been known to have diabetes for 20 years. Her condition had been controlled by diet and administration of 100 units of insulin preparation daily. In an effort to improve the intensity of her control she had been given in addition 1 gr of chlorpropamide¹ per day.

2. About three weeks later she noted general malaise, weakness and loss of appetite, followed in a few days by the discovery of dark urine, light stools and rash on her trunk. With the passage of an additional week by which time she had taken a total of 27 gr of chlorpropamide, she noted jaundice. There was no pain, fever, nausea, or vomiting. Her past history did not reveal liver or bile duct diseases. She was hospitalized on October 10 for further studies.

3. The findings of the physical examination showed the presence of jaun­dice and diffuse rash on the chest and abdomen. The liver was enlarged and there was tenderness on palpation.

4. The blood analysis revealed serum bilirubin to be at the level of 8.9 mg%, the hemoglobin level was 11.6 gr% and the white blood cell count 7, 600

per cubic millimetre. Platelets averaged to 490, 000 per cubic millimetre. Uri-nalysis revealed the presence of bile.

5. The biopsy of the liver performed on October 16 showed normal liver structure. There was mild pigmentation of Kupffer cells² and slight capillary bile stasis. Some inflammatory reaction in the portal tracts was noted, but no inflammatory or degenerative changes were observed in the hepatic cells.

6. The patient was discontinued chemotherapy with chlorpropamide and her diabetes was controlled by a diet containing 150 gr of carbohydrates, 75 gr of proteins and 80 gr of fats and the administration of 80 units of insulin prepa­ration daily.

7. Her symptoms having been relieved after a month's treatment, the patient was discharged on November 14. She complained of neither jaundice nor any other symp­toms when she was seen for a follow-up examination three months later.

Notes

1. chlorpropamide - хлорпропамид (название препарата)

2. Kupffer fkupfa] cells - купфсровские клетки в печени