Drug-related Steatohepatitis/Phospholipidosis

Drug-related Steatohepatitis/Phospholipidosis

Laura Webb Lamps, MD



  • Steatohepatitis as consequence of drug exposure

    • Some seem to produce their effect by exacerbating underlying nonalcoholic steatohepatitis


Commonly Implicated Drugs

  • Amiodarone (antiarrhythmic)

    • Strongly tissue-bound, becomes concentrated in liver

  • Nifedipine (calcium channel blocker)

  • Perhexiline maleate (calcium channel blocker)

  • Methotrexate (immunosuppressant/antineoplastic)

    • Hepatic injury usually occurs after long-term use

  • Tamoxifen (estrogen antagonist)

  • Steroids

  • Naproxen (NSAID)

  • Trimethoprim-Sulfa (antibiotic)

  • Total parenteral nutrition

    • Steatosis particularly seen in adults

  • Anti-HIV drugs

    • Induce syndrome of dyslipidemia, fat maldistribution, insulin resistance

      • Known as HIV-associated lipodystrophy syndrome or HIV-associated metabolic and morphological abnormality syndrome (HAMMAS)



  • Variably present constitutional complaints, hepatomegaly, jaundice

    • May be asymptomatic (especially methotrexate injury)

  • Symptoms may present after months to years of therapy

Laboratory Tests

  • Elevated transaminases

    • May be normal despite hepatic injury, especially in patients on methotrexate


Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Drug-related Steatohepatitis/Phospholipidosis

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