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

THE CASE 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 taking etizolam (0.5 mg daily) for insomnia for more than 5 years and for the previous 6 months had been taking tibolone (2.5 mg daily) for a postmenopausal climacteric syndrome. Urinary incontinence had been diagnosed 2 months before admission, and flavoxate (200 mg three times daily) was added to her treatment. The results of the patient’s liver function tests were normal when incontinence was diagnosed and her medical history was not remarkable for any other diseases, drug addiction, alcohol abuse or blood transfusions. She also denied recent travel abroad and a family history of liver disease. At the time of admission, the patient’s vital signs were stable and there was no abdominal pain, pathological bowel sounds or rebound tenderness on physical examination. Laboratory tests showed an increase in both the concentration of unconjugated and conj