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KEY WORDS: bupropion; hepatotoxicity; drug-induced hepatitis; abnormal liver enzymes.
Bupropion is an antidepressant that blocks the neuronal uptake of serotonin and norepinephrine and inhibits the neuronal reuptake of dopamine (1). Although asymptomatic, but significant elevation of serum transaminases was reported in a single case (2), previous toxicological studies have shown that bupropion causes infrequent and mild increases of serum liver enzymes (1, 3, 4). In this study, we report a patient who developed typical acute hepatitis after receiving bupropion for depression.
CASE REPORT
R.B. is a 41-year-old African American male who had a history of chronic hepatitis C and has never received antiHCV treatment due to persistently normal liver enzymes. He was diagnosed as having major depression about seven weeks prior to his presentation. Bupropion, 200 mg once a day, was started then. By the end of sixth week, 41 days after bupropion was started, he noted subjective fever, chills, malaise, muscle aches, anorexia, and nausea. He voluntarily discontinued bupropion the day after he noted the above symptoms (ie, day 42). He sought medical attention four days after he became ill. He took over-the-counter ibuprofen 1-2 tablets a day for his symptoms for three days prior to admission, but denied acetaminophen, herbal, or other prescribed or over-the-counter medications in the past six months. The patient had a history of alcoholism and injection drug use, but none for 18 months.
At his initial presentation, his physical examination was pertinent for fever (101.8[degrees]F), scleral ictericus, and a moderately enlarged, soft liver. He had no altered mental status, skin rashes, spider angiomatas, palmer erythema, or splenomegaly.
His initial biochemical tests were significant for total serum protein 5.8 g/dl, albumin 2.9 g/dl, total bilirubin 3.8 mg/dl, direct bilirubin 3.0 mg/dl, alkaline phosphotase 232 units/liter, AST 9040 units/liter, ALT 6660 units/liter, LDH 5260 units/liter, and platelet count 133,000/mm3. His peak prothrombin time was 20.0 sec (INR 1.75) at day 7 after onset. Urine toxic screen on admission was negative. The viral...