Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016
Abstract Methimazole is a commonly prescribed drug for hyperthyroidism and is generally well‐tolerated, with complications occurring in less than 10% of treated patients. To our knowledge, there are approximately 30 reported cases of drug‐induced liver injury (DILI) associated with the use of methim...
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| Format: | Article |
| Language: | English |
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Wiley
2025-02-01
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| Series: | JGH Open |
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| Online Access: | https://doi.org/10.1002/jgh3.13042 |
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| author | Salomon Chamay Ari Alter Rooshi Parikh Shivam Khatri Deepa Budh Mitchell Spinnell |
| author_facet | Salomon Chamay Ari Alter Rooshi Parikh Shivam Khatri Deepa Budh Mitchell Spinnell |
| author_sort | Salomon Chamay |
| collection | DOAJ |
| description | Abstract Methimazole is a commonly prescribed drug for hyperthyroidism and is generally well‐tolerated, with complications occurring in less than 10% of treated patients. To our knowledge, there are approximately 30 reported cases of drug‐induced liver injury (DILI) associated with the use of methimazole in the literature. DILI is a challenging diagnosis and can often mimic many forms of acute and chronic hepatitis. The pattern of liver injury can be hepatocellular, cholestatic, or mixed in nature. The R‐value is a useful tool for characterizing the pattern of liver injury, while the Roussel Uclaf Causality Assessment Method (RUCAM) aids with quantifying the likelihood of DILI. The updated version of RUCAM from 2016 was used in this report. We present a case of a 72‐year‐old female who developed cholestatic DILI secondary to methimazole with a calculated RUCAM score of 8, initially obscured by both imaging and endoscopic findings concerning for hepatobiliary obstruction. |
| format | Article |
| id | doaj-art-7a213f144b4a4e1ca21521ed3eb47dca |
| institution | DOAJ |
| issn | 2397-9070 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj-art-7a213f144b4a4e1ca21521ed3eb47dca2025-08-20T02:45:15ZengWileyJGH Open2397-90702025-02-0192n/an/a10.1002/jgh3.13042Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016Salomon Chamay0Ari Alter1Rooshi Parikh2Shivam Khatri3Deepa Budh4Mitchell Spinnell5Division of Internal Medicine, Department of Medicine St. Barnabas Hospital Bronx New York USATouro University New York New York USACUNY School of Medicine New York New York USACUNY School of Medicine New York New York USADivision of Internal Medicine, Department of Medicine St. Barnabas Hospital Bronx New York USADivision of Gastroenterology, Department of Medicine Englewood Hospital Englewood New Jersey USAAbstract Methimazole is a commonly prescribed drug for hyperthyroidism and is generally well‐tolerated, with complications occurring in less than 10% of treated patients. To our knowledge, there are approximately 30 reported cases of drug‐induced liver injury (DILI) associated with the use of methimazole in the literature. DILI is a challenging diagnosis and can often mimic many forms of acute and chronic hepatitis. The pattern of liver injury can be hepatocellular, cholestatic, or mixed in nature. The R‐value is a useful tool for characterizing the pattern of liver injury, while the Roussel Uclaf Causality Assessment Method (RUCAM) aids with quantifying the likelihood of DILI. The updated version of RUCAM from 2016 was used in this report. We present a case of a 72‐year‐old female who developed cholestatic DILI secondary to methimazole with a calculated RUCAM score of 8, initially obscured by both imaging and endoscopic findings concerning for hepatobiliary obstruction.https://doi.org/10.1002/jgh3.13042cholestatic liver injurydrug‐induced liver injurymethimazole‐induced liver injuryobstructive jaundiceperiampullary diverticulosisupdated RUCAM |
| spellingShingle | Salomon Chamay Ari Alter Rooshi Parikh Shivam Khatri Deepa Budh Mitchell Spinnell Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016 JGH Open cholestatic liver injury drug‐induced liver injury methimazole‐induced liver injury obstructive jaundice periampullary diverticulosis updated RUCAM |
| title | Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016 |
| title_full | Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016 |
| title_fullStr | Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016 |
| title_full_unstemmed | Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016 |
| title_short | Methimazole‐induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum: A case report with reference to the updated RUCAM of 2016 |
| title_sort | methimazole induced cholestasis initially obscured by an incidental finding of a large periampullary diverticulum a case report with reference to the updated rucam of 2016 |
| topic | cholestatic liver injury drug‐induced liver injury methimazole‐induced liver injury obstructive jaundice periampullary diverticulosis updated RUCAM |
| url | https://doi.org/10.1002/jgh3.13042 |
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