Propofol-Induced Hepatitis

OBJECTIVES: To present a rare case of propofol-induced hepatitis. MATERIALS AND METHODS: A 59-year old man was referred to our department because of suspicion of toxic hepatitis after propofol anaesthesia for endoscopic colonoscopy. RESULTS: The patient had jaundice, increased transaminases demonstrating liver necrosis, and liver stiffness of 18 kPa. Liver biopsy revealed bridging necrosis and initial post-collapse fibrosis. Following therapy with steroids and N-acetyl cysteine, the patient was discharged on the seventh day after admission in good general condition. CONCLUSION: Although propofol is considered safe, it can cause acute hepatitis, the seventh published case of which is reported here. Importantly, treatment with N-acetyl cysteine, a radical scavenger, but especially with steroids resulted in hepatic improvement. LEARNING POINTS: Drug-induced hepatitis is a severe illness caused by a large variety of agents, including many considered safe. It can occur in the absence of predisposing liver abnormality or disease. If the condition is correctly identified, clinical and laboratory abnormalities can be reversed with appropriate treatment.