Drug-induced hepatic injury caused by an aldose reductase inhibitor, epalrestat

Abstract

A 68-year-old woman was admitted to our hospital with acute liver injury. About 2 months before admission, she developed hyperlipidemia, diabetes mellitus, and peripheral neuropathy and was treated with insulin, rosuvastatin, and epalrestat. Laboratory data showed elevations of aspartate aminotransferase and alanine aminotransferase. According to the diagnostic scale proposed at the Digestive Disease Week-Japan 2004, her liver injury was classified as hepatocellular type and judged as "highly possible". The drug-lymphocyte stimulation test was positive for epalrestat. Liver biopsy showed portal inflammation with infiltrated lymphocytes and intralobular spotty necrosis. Taken together, the liver injury was diagnosed as epalrestat-induced hepatic injury. After the cessation of epalrestat, the liver injury gradually and slowly recovered. © 2011 The Japan Society Of Hepatology.