Abstract

A 39-year-old woman presented to the hospital with upper abdominal pain, vomiting, and malaise for two days. Two weeks before admission her primary physician prescribed pantoprazole for gastroesophageal reflux symptoms. She denied the intake of other medications or herbal products. Her past medical history was remarkable for anemia secondary to heavy menses. She had pica for ice for many years and was transfused several years ago for a low hemoglobin level. Clinical examination and laboratory tests suggested a diagnosis of hepatitis. Test results were as follows: prothrombin time 16.6 seconds, international normalized ratio 2.1, total bilirubin 1.2 mg/dL, direct bilirubin 0.4 mg/dL, alkaline phosphatase 89, aspartate aminotransferase (serum glutamic-oxaloacetic transaminase) 964, alanine aminotransferase (serum glutamic-pyruvic transaminase) 3,061 IU/L, gamma glutamyl transpeptidase 252 IU/L, albumin 3.1 g/dL, total protein 5.9 g/dL, hemoglobin 8.1 mg/dL, and mean corpuscular volume 72. Duplex ultrasound revealed no evidence of hepatosplenomegaly or bile obstruction. Doppler ultrasounds revealed normal flow within the hepatic arteries and veins. Serologies excluded an infectious, metabolic, or autoimmune cause of hepatitis. The patient's condition and laboratory tests gradually improved with symptomatic treatment and the discontinuation of pantoprazole, suggesting proton-pump-inhibitor-induced hepatitis.