Lisinopril-Induced Liver Injury: An Unusual Presentation and Literature Review

Authors

• Ammar Al-Rifaie Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
• Mir Azam Khan Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
• Amjad Ali Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
• Asha Kumari Dube Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
• Dermot Gleeson Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
• Barbara Hoeroldt Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

ammar.al-rifaie2@nhs.net

Keywords

Abstract

Lisinopril is an angiotensin converting enzyme inhibitor (ACE-I) that has been on market for more than 25 years. ACE-I are usually well tolerated and rarely have serious or life-threatening side effects. We describe an unusual presentation of fulminant hepatic cholestasis probably secondary to lisinopril. To our knowledge, this is the second case report which shows lisinopril-induced liver injury though a cholestatic mechanism. The patient was a 59-year-old woman with type 2 diabetes, a high body mass index and hypertension, who presented with a 5-week history of jaundice and itching. She had been started on lisinopril for diabetic nephropathy 8 weeks before admission. Other causes for cholestasis had been excluded through non-invasive immunology and virology screening, an ultrasound of the liver, magnetic resonance cholangiopancreatography and a liver biopsy. The biopsy was consistent with drug-induced liver injury. Lisinopril was stopped 2 weeks before admission. The patient’s hospital stay was complicated by contrast nephropathy and influenza A which were both treated appropriately. Unfortunately, the liver cholestasis did not completely resolve following withdrawal of lisinopril and the patient died after 4 months. A literature search yielded only six other reported cases of lisinopril-induced liver injury. Five cases described hepatocellular damage and one showed cholestatic injury.