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. 2020 Apr 15;7(7):001600.
doi: 10.12890/2020_001600. eCollection 2020.

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

Ammar Al-Rifaie  1 , Mir Azam Khan  1 , Amjad Ali  1 , Asha Kumari Dube  1 , Dermot Gleeson  1 , Barbara Hoeroldt  1
Affiliations

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

Ammar Al-Rifaie et al. Eur J Case Rep Intern Med. .

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.

Learning points: Angiotensin converting enzyme inhibitors (ACE-I) rarely have serious or life-threatening side effects.Lisinopril-induced liver injury can present as hepatocellular or cholestatic injury.Severe hepatotoxicity secondary to lisinopril can be life threatening irrespective of the liver injury pattern.

Keywords: Angiotensin converting enzyme inhibitors; cholestasis; drug-induced liver injury; lisinopril.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Portal fibrosis and bridging fibrosis (Orcein stain). Black arrowheads indicate original portal areas, while clear arrows indicate new elastic fibres
Figure 2
Figure 2
Cholestatic hepatitis (H&E stain). Canalicular cholestasis is indicated by arrows (yellow-green pigment)
See this image and copyright information in PMC

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