[Morphology and pathogenesis of liver injury produced by dihydralazine , propranolol and ketophenylbutazone].

Morphologically identical liver damage may be caused by dihydralazine (Depressan, Nepresol) and propranolol (Obsidan, Dociton). Among 24 patients with clinical manifestations of drug-induced hepatitis associated with Depressan or Obsidan treatment, liver biopsies in 15 showed drug hepatitic changes with confluent necrosis. In five of these cases this finding was combined with cholangiolitis, in four there was a drug-induced hepatopathy resembling the picture of viral hepatitis. In 20 cases of Ketazon-induced liver damage the biopsy demonstrated toxic hepatosis with or without cholestasis, reactive hepatitis or cholangiolitis. A drug-related hepatitis with central lobular necrosis was observed in one patient with Ketazon-induced liver damage. In 28 patients a lymphocyte proliferation test was undertaken to confirm a causal relationship between the use of either Depressan, Obsidan or Ketazon and the morphologically demonstrated liver damage. The test was positive in 25 cases (18 with Depressan, 2 with Obsidan and 5 with Ketazon). In several uncertain cases, for example, exposure to both Depressan and Obsidan or to Ketazon and Rewodina, the morphologic picture could be attributed to a specific medication by the use of the lymphocyte proliferation test. The results of the lymphocyte proliferation test and the morphologic findings emphasize the role of cell-mediated immune reactions in the pathogenesis of liver damage from dihydralazine, propranolol, and ketophenylbutazone.