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J Clin Gastroenterol. 1984 Apr;6(2):145-8.

Severe and prolonged oral contraceptive jaundice.

Abstract

Oral contraceptives frequently produce mild hepatocellular dysfunction, but only rarely cause jaundice. The syndrome of oral contraceptive jaundice is usually mild, with rapid resolution upon withdrawal of the drug. We describe a patient who had a severe illness with marked jaundice after one cycle of oral contraceptives. Her symptoms progressively worsened and serum bilirubin increased for almost 3 months after discontinuation of oral contraceptives. Full recovery ultimately occurred. Her severe and prolonged course demonstrates the wide spectrum of oral contraceptive jaundice.

PIP:

This paper presents a case of a patient who developed a severe illness with marked jaundice after 1 cycle of oral contraceptives (OCs). Although effects on liver physiology are a frequent but clinically insiginificant consequence of OC use, major hepatic dysfunction with clinically apparent jaundice occurs rarely. This patient's illness was manifest initially by pruritus and later was characterized by marked jaundice with mild to moderate transaminase and alkaline phosphatase elevations. Serologic studies for hepatitis and primary biliary cirrhosis were negative, and extrahepatic biliary obstruction was excluded by cholangiography. Liver biopsy revealed cholestasis without features of hepatitis. The patient, 22 years of age, has shown gradual resolution of jaundice and pruritus and normalization of liver tests over a 12-month period. OC-induced cholestasis appears to be associated primarily with the estrogen component of OCs, although the progeston component may enhance the cholestatic effects of the estrogen. This case demonstrates that, although typically benign, OC jaundice may occasionally be manifest by a severe and lengthy clinical illness. Since patients with prior jaundice of pregnancy often experience a recurrence of cholestatic symptoms if OC use is resumed, OC use should be avoided in such cases.

PMID:
6715853
[Indexed for MEDLINE]

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