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Dr. SH
Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8770
Experience:  Doctor of Medicine
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Could drug induced hepatitis trigger PBC can you show evidence

Resolved Question:

Could drug induced hepatitis trigger PBC can you show evidence of this?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. SH replied 2 years ago.
Dr. Shahzad MD :

Hi there. Thank you for your question. I will be helping you out with your queries

Dr. Shahzad MD :

What drugs in particular are you talking about?

Customer:

Isoniazid and rifampicin, Overdose for several weeks resulting in hepatitis. AMA negative before overdose AMA positive after overdose.

Dr. Shahzad MD :

ok

Dr. Shahzad MD :

These medications can cause PBC like findings but not PBC itself.

Dr. Shahzad MD :

PBC stands for 'primary biliary cirrhosis'

Dr. Shahzad MD :

By primary we mean 'no known cause'.

Dr. Shahzad MD :

and the antibody test is positive with it.

Dr. Shahzad MD :

When it is caused due to drugs it is no longer primary.

Dr. Shahzad MD :

It is then secondary.

Customer:

I had a negative Antibody test prior to the overdose and a positive test after the overdose

Dr. Shahzad MD :

So it may just have been a coincidence as far as I am concernd.

Dr. Shahzad MD :

I am not sure why that happened.

Customer:

from my research i have found that isoniazid depleted the body of glutathione. and also that xenobiotics that deplete glutathione can lead do odc-e2 abnormalities and cause a loss of tolerence and lead to the development of pbc

Customer:

PDC-E2 sorry

Dr. Shahzad MD :

It can cause a clinical picture similar to it.

Dr. Shahzad MD :

But that would not exactly be PBC, if you see what I mean.

Dr. Shahzad MD :

It should not cause the antibody test to be positive as far as I am concerned.

Dr. Shahzad MD :

But then again there may be a case report or two suggesting that it may have happened.

Customer:

i read that %35 of people that overdose on Paracetamol have a positive AMA after for the same reasons

Dr. Shahzad MD :

Positive AMA is almost always followed by a liver biopsy to confirm the diagnosis.

Dr. Shahzad MD :

These antibody tests are not very reliable.

Dr. Shahzad MD :

How are your liver enzymes?

Customer:

they were raised at the time of the hepatitis but came down. they then raised years after as the pbc caused more damage and now since taking urso they have come down again

Dr. Shahzad MD :

ok so since how long have you been officially diagnosed with PBC?

Dr. Shahzad MD :

Have you had a liver biopsy as yet?

Customer:

a couple of years but they doctors say i have had it since the hepatitis 10 years ago
no biopsy yet

Dr. Shahzad MD :

ok

Dr. Shahzad MD :

So it is a mild disease if I am not wrong.

Dr. Shahzad MD :

But I still do not think this is drug related.

Dr. Shahzad MD :

Although the test may have become positive after you took the drugs that you mentioned but I still do not believe it is drug related if the final diagnosis is PBC like you say.

Customer:

can xenobiotics trigger ama production

Dr. Shahzad MD :

It is possible

Customer:

i was also reading about oxidative stress leading to ama production. and an overdose of these drugs do cause oxidative stress in the mitochiondria

Dr. Shahzad MD :

But something that is rare.

Dr. Shahzad MD :

Yes it is possible.

Dr. Shahzad MD :

But rare.

Dr. Shahzad MD :

Usually, in the vast majority of cases, there is no cause.

Dr. Shahzad MD :

But like you say categorically that you had a negative AMA before taking medications and positive after taking the medications so a xenobiotic cause is very much possible.

Dr. Shahzad MD :

But this is something that is pretty rare.

Customer:

I am a man and for a man in his 30s to get pbc you understand it is extremely rare. so to get it at that time when there are links between the two things, is it not more likely the cause?

Dr. Shahzad MD :

I agree with your thoughts.

Dr. Shahzad MD :

Particularly since your test result, like you mentioned, became positive after taking the drugs.

Dr. Shahzad MD :

So yes it is a possibility, I agree with you.

Dr. Shahzad MD :

In fact, after reading a few articles myself as I speak, I agree with what you are saying.

Dr. Shahzad MD :

So something that is extremely rare but yes in your case seems to be the cause.

Customer:

would you be prepared to put your thoughts into a letter?

Dr. Shahzad MD :

Letter?

Customer:

i am looking for help in proving that there is a possibility of the overdose being the cause of pbc and although i know the evidence is there i would like somebody that is more qualified, to help

Dr. Shahzad MD :

So what do you want me to do?

Dr. Shahzad MD :

Overdose still would not be proven as a cause.

Customer:

no not proven but shown as a posibility

Dr. Shahzad MD :

Even if there is evidence, there is evidence in regards ***** ***** fact that xenobiotics cause damage to the liver membrane causing loss of tolerance and formation of antibodies.

Dr. Shahzad MD :

formation of antibodies happen more commonly in people who are genetically susceptible.

Dr. Shahzad MD :

So not all people will have this kind of problem.

Customer:

yes but you must encounter a trigger

Dr. Shahzad MD :

Yes that is true.

Dr. Shahzad MD :

So yes it can be a trigger.

Dr. Shahzad MD :

So it is a possibility yes.

Customer:

thank you for your help

Dr. Shahzad MD :

You are most welcome
Wish you all the best.
I would appreciate it if you rate me by clicking on one of the smilies below.
Kindest regards

Customer:

thank you

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