Green sweat: An atypical finding in drug-induced liver disease

摘要

A 36-year-old man was admitted to the gastroen-terology ward for jaundice and a history of drug abuse. He had been using fluconazole 150 mg/week for 6 months, cyclobenzaprine and meloxicam irregularly for 60 days, and finally, stanozolol and testosterone for muscle mass gain for 45 days. On physical examination he did not exhibit flapping or any signs of chronic liver disease. The following laboratory results were obtained: Total bilirubin 43.4 mg/dl, direct bilirubin 36.3 mg/dl, aspartate aminotransferase 50 U/L, alanine aminotransferase 67 U/L, alkaline phosphatase 276 U/L, gamma glutamyltransferase 72 U/L, creatinine 1.7 mg/dl and international normalized ratio 0.92. Tests for the viral markers anti-HAV IgM, HBsAg, anti-HBc and anti-HCV were negative. Liver biopsy showed cholestatic hepatitis with confluent necrosis.