Acute liver damage induced by mesalazine enteric-coated tablets

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A 70-year-old male patient received pantoprazole because of stomachache with bloody stools for 1 day and positive fecal occult blood test. The laboratory tests before medication showed total bilirubin(TBil) 11.3 μmol/L, direct bilirubin(DBil) 4.0 μmol/L, alkaline phosphatase(ALP) 72 U/L, alanine aminotransferase(ALT) 59 U/L, aspartate aminotransferase(AST) 55 U/L, and glutamyltransferase(γ-GT ) 65 U/L. On day 4 after medication, the patient was diagnosed as ulcerative colitis. Pantoprazole was stopped and cimetidine, mesalazin enteric-coated tablets, compound glutamine entersoluble capsules, and live combined bifidobacterium and lactobacillus tablets were given. After 3 days of treatments, formed stools appeared and abdominal pain and bloody stools disappeared. On day 6, cimetidine was stopped. On day 11, the laboratory tests showed TBil 37.8 μmol/L, DBil 20.8 μmol/L, ALT 660 U/L, AST 236 U/L, γ-GT 424 U/L, and ALP 217 U/L. Drug-induced liver injury was diagnosed. Then mesalazin was withdrawn, other drugs continued, and liver protection treatment was given at the same time. After 10 days of treatment, the laboratory tests showed TBil 21.3 μmol/L, DBil 9.4 μmol/L, ALT 97 U/L, AST 27 U/L, γ-GT 247 U/L, and ALP 122 U/L. At one and a half months of follow-up, no abnormality occurred. Key words: Chemical and drug induced liver injury; Mesalamine

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