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Article: Acute Fulminant Hepatic Failure in a Woman Treated With Phenytoin and Trimethoprim-Sulfamethoxazole.
- Article from:
- Archives of Pathology & Laboratory Medicine
- Article date:
- December 1, 2000
- Author:
CopyrightCOPYRIGHT 2000 College of American Pathologists. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)
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Hydantoins and sulfonamides have been incriminated in hepatic damage either via idiosyncrasy or intrinsic toxicity. Phenytoin (DPH) is converted in the liver by parahydroxylation to 5-(p-hydroxyphenyl)-5-phenylhydantoin and then conjugated to glucuronic acid.[1] The hepatic injury varies from almost trivial to massive necrosis and is usually hepatocellular, although a mixed hepatocellular/cholestatic pattern is seen occasionally.[2] Trimethoprim-sulfamethoxazole (TMP-SMZ) is also metabolized by glucuronide conjugation.[3] The injury is usually cholestatic or mixed, although hepatocellular damage may occur, especially in immunocompromised patients.[4,5] ...