Cholestatic liver injury can be caused by a variety of drugs and is difficult to treat. We report two patients, a 22 year old male and a 55 year old female, with
drug induced
cholestasis caused by
anabolic-androgenic steroids (
silabolin and
nandrolone) and by
fluoxetine, respectively. Both patients presented with massive
jaundice and severe
pruritus resulting in
sleep deprivation and suicide ideation. Laboratory examination revealed signs of
cholestasis. Medical treatment was ineffective; therefore, extracorporeal
albumin dialysis using the molecular adsorbent recirculating system (MARS) was started. Three treatments with a mean duration of 16 hours were performed in each patient. The procedure was well tolerated by the patients and resulted in a sustained relief of
pruritus as well as in a decline of plasma
bilirubin and serum 3alpha-hydroxy
bile acid levels. The mean plasma
bilirubin concentration decreased from 25.27 mg/dl to 10.7 mg/dl; the mean serum 3alpha-hydroxy
bile acid concentration decreased from 299 micromol/L to 88 micromol/L. After 2 months, the
pruritus had nearly vanished in both patients, and there was a further decline of
bilirubin levels after discharge from hospital. In conclusion, extracorporeal
albumin dialysis appears to be a therapeutic option in severe
drug induced
cholestasis refractory to medical treatment.