Prolonged cholestasis after raloxifene and fenofibrate interaction: A case report

Abstract

Assigning causality in drug-induced liver injury is challenging particularly when more than one drug could be responsible. We report a woman on long-term therapy with raloxifen who developed acute cholestasis shortly after starting fenofibrate. The picture evolved into chronic cholestasis. We hypothesized that an interaction at the metabolic level could have triggered the presentation of hepatotoxicity after a very short time of exposure to fenofibrate in this patient. The findings of an overexpression of vascular endothelial growth factor in the liver biopsy suggest that angiogenesis might play a role in the persistence of toxic cholestasis.

Figure 1

A: The first liver biopsy in December 2003 showing mild to moderate granular stain in hepatocytes of zone 3; B: The second liver biopsy in February 2004 showing diffuse VEGF stain with predominance of zone 3 (original magnification 200 x).