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You are here: Home / Articles / Case Report: A Patient with Gout Develops Granulomatous Hepatitis

Case Report: A Patient with Gout Develops Granulomatous Hepatitis

November 16, 2019 • By Raj Vachhani, MD, & Angelo L. Gaffo, MD, MSPH

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Conclusion

Allopurinol-induced granulomatous hepatitis is a rare phenomenon that rheumatologists should be aware of given the frequency with which this drug is used. A discovery of this condition should prompt a change in therapy to another urate-lowering agent, such as febuxostat, which has not had any reported cases of granulomatous hepatitis.

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November 2019, October 2008

This case serves as a reminder that any clinical presentation without a clear etiology warrants a review of the patient’s medication list. It is not possible to know every rare, adverse reaction to medications, but identifying a temporal relationship between a drug and a clinical presentation can help guide our clinical suspicions.  

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Raj Vachhani, MD photoRaj Vachhani, MD, is a third-year postgraduate, studying internal medicine at the University of Alabama, Birmingham.

Angelo L. Gaffo, MD, MSPHAngelo L. Gaffo, MD, MSPH, is the rheuma­tology section chief at the Birmingham VA Medical Center and associate professor of medicine in the Division of Rheumatology at the University of Alabama, Birmingham.

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References

  1. Lamps LW. Hepatic granulomas: A review with emphasis on infectious causes. Arch Pathol Lab Med. 2015 July;139(7):867–875.
  2. Zakim D, Boyer TD (Eds). Hepatology: A textbook of liver disease. Vol. 3. 3rd ed. Philadelphia: WB Saunders; 1996:1472.
  3. Culver EL, Watkins J, Westbrook RH. Granulomas of the liver. Clin Liver Dis (Hoboken). 2016 Apr 27;7(4):92–96.
  4. Simmons F, Feldman B, Gerety D. Granulomatous hepatitis in a patient receiving allopurinol. Gastroenterology. 1972 Jan;62(1):101–104.
  5. Iqbal U, Siddiqui HU, Anwar H, et al. Allopurinol-induced granulomatous hepatitis: A case report and review of literature. J Investig Med High Impact Case Rep. 2017 Sep 8;5(3):2324709617728302.
  6. Qurie A, Musa R. Allopurinol. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan.

Pages: 1 2 3 | Single Page

Filed Under: Conditions, Crystal Arthritis Tagged With: Allopurinol, Gout Resource Center, granulomatous hepatitisIssue: November 2019, October 2008

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  • Case Report: Diagnosing, Treating Hepatitis B-Linked Polyarteritis Nodosa

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