Chronic Active and Lupoid Hepatitis Caused by a Laxative, Oxyphenisatin

In six patients with chronic constipation, chronic active liver disease developed after one to two years of daily ingestion of laxative preparations containing oxyphenisatin; in a seventh liver disease occurred after ingestion of laxatives of unknown composition. Clinical features were jaundice, fatigue, firm hepatomegaly and, occasionally, spider angiomas and splenomegaly. Laboratory abnormalities included an increase in transaminase activity of 10 to 40 times, decreased prothrombin, depressed serum albumin and raised globulin. Two patients had positive LE-cell tests, two others had antinuclear antibody and three had smooth-muscle antibody; none had hepatitis-associated antigen. Liver biopsies showed areas of collapse and fibrosis, with stromal lymphocytic infiltrate and focal areas of hepatocytolysis. All patients improved after changing laxatives. Challenge with oxyphenisatin in three patients caused abrupt rises in transaminase activity. A toxic etiology should be considered, therefore, in al...