Jacobs J W, Van der Weide F R, Kruijsen M W
Department of Rheumatology, University Hospital Utrecht, The Netherlands.
Br J Rheumatol. 1994 Aug;33(8):770-3. doi: 10.1093/rheumatology/33.8.770.
A 37-yr-old woman with RF-positive RA developed cholestatic hepatitis after 10 days of D-penicillamine therapy. This was discontinued immediately. The cholestasis persisted for the remaining 14 months of her life. Severe hypercholesterolemia developed with xanthelasmata and eventually pancytopenia, which was caused by a massive infiltration of the bone marrow by lipid-containing foam cells. The patient died of sepsis. Review of the literature shows intrahepatic cholestasis to be a rare and idiosyncratic complication of D-penicillamine therapy. To our knowledge, ours is the first documented case of persistent cholestatic icterus.
