Case report: mixed cholestatic/hepatocellular liver injury induced by the herbicide quizalofop-p-ethyl

Abstract

Context: Quizalofop-p-ethyl is an often applied, slightly toxic herbicide for which no severe toxicity has been reported in humans.

Case presentation: We present the case of a farmer exposed to quizalofop-p-ethyl who presented with obstructive cholestasis. A complete workup disclosed no other cause of liver pathology, but liver biopsy established drug-induced hepatotoxicity. The patient was treated with ursodeoxycholic acid and prednisolone, and was recovered fully 70 days after his exposure to the herbicide. The patient was followed for the next 9 months.

Conclusion: Quizalofop-p-ethyl can induce a mixed cholestatic/hepatocellular liver injury. We discuss possible mechanisms implicated in liver injury after exposure to quizalofop-p-ethyl.

Relevance to clinical or professional practice: In patients presenting with mixed cholestatic/ hepatocellular liver injury, occupational exposure to quizalofop-p-ethyl in the course of agricultural use should be investigated.

Keywords: autoimmune drug-induced liver injury; cholestatic/hepatocellular liver injury; drug-induced liver injury; hepatotoxicity; herbicide; quizalofop-p-ethyl.

Figure 1

QpE-induced hepatotoxicity shown by a time course of liver biochemistry results for AST, ALT, ALP, γ-GT, and TBIL.

Figure 2

QpE-induced hepatotoxicity indicated by (A) Moderate portal inflammatory infiltrates consisting of neutrophils, lymphocytes (long arrow), and eosinophils (short arrows), and (B) moderate intralobular cholestasis (arrows). Slides are stained with hematoxylin and eosin. Bar = 100 μm and applies to (A) and (B).