Reactions 1511, p19 - 26 Jul 2014

SDydrogesterone/follitropin-α/progesterone

Hepatitis: case reportA 39-year-old woman developed hepatitis while receiving

dydrogesterone [Duphaston], follitropin-α [Gonal-F], andprogesterone [Utrogestan].

The woman was undergoing in vitro fertilization (IVF)treatment for her primary subfertility. She had received twoprevious IVF cycles without experiencing jaundice. For herthird IVF cycle, ovarian stimulation was performed usingfollitropin-α [Gonal-F] 225 IU [route not stated] from day 2until day 12 (11 days) with the addition of ganirelix on day 8until trigger day on day 12. On trigger day 12, she receivedchoriogonadotropin-α with retrieval of the oocytes performedon day 14. Luteal support was provided with oraldydrogesterone 10mg thrice a day and per vaginalprogesterone 100mg thrice a day, in addition to SC chorionicgonadotropin. The woman reported pruritus all over her bodyespecially on her palms and soles and increasing jaundice10 days after embryo transfer. She underwent a series oflaboratory investigations which revealed raised bilirubin leveland elevated liver enzymes. Her radiological investigation wasunremarkable. She was diagnosed with hepatitis. A provisionaldiagnosis of drug-induced hepatitis was eventually made.

The woman’s jaundice lasted for almost 2 months. She wastreated with ursodeoxycholic acid and lactulose whichresolved her jaundice. Her bilirubin and liver enzymesgradually normalised and medication ended.

Author comment: "A potential drug induced hepatitis inthis case could be due to the progesterone. Dydrogesterone-induced hepatitis was first described by Altintas et al. in2004." "[Follitropin-α] is the other potential drug that maycause the hepatitis".Mustafa KB, et al. Severe jaundice post embryo transfer: A case report. GiornaleItaliano di Ostetricia e Ginecologia 36: 229-231, No. 1, Jan-Feb 2014. Availablefrom: URL: http://www.giog.it/index.php?PAGE=issue&ID_ISSUE=731 -Malaysia 803106160

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Reactions 26 Jul 2014 No. 15110114-9954/14/1511-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved