Theophylline Hepatitis in elderly patients: 2 case reports

Case 1: A 65-year-old woman was hospitalised with a severe attack of asthma accompanied by significant respiratory obstruction and bronchial hypersecretion . Therapy consisted of salbutamol [albuterol] , IV theophylline, corticosteroids and antibiotics in itially, then sustained-release theophylline (, Oilantrane '), fenoterol (,Berotec ') , prednisolone ('Solupred ') administered orally and beclomethasone aerosol ('Becotide') She was discharged 19 days after admission but requ ired IV theophyll ine a month later for worsening of respiratory obstruction .

The pat ient was readmitted 5 weeks after initial admission , wi th right hypochondrial pain, nausea and vomiting . Laboratory i nvestigat ions showed elevated AL T and AST wi th no evidence of non-A or non-B hepatitis and negat ive antigen tests for hepat itis A and B antigen . Theophylline had been withdrawn 1 day prior to admission . Rein troduction of theophylline 8 days a fter admission resul ted in an increase in AL 1. Hepat ic function normalised wi th drug withdrawal and the patient was discharged receiving 'Serotec' and 'Becot ide '. Hepat ic function cont inued to remain normal at follow-up a few months later.

Case 2. A 69-year-old man with a prolonged history of intrinsic asthma was hospitalised following an asthmatic attack. Clinical examination revealed respiratory obstruction and therapy was init iated with corticosteroids 20 mg/ day ('Soluprid ') and sustained-release theophylline 600 mg/ day (,Oilatrane ,) On hospital day 4 an increase in gamma-glutamyl transferase (GGT) occurred and on day 6 AL T was elevated , reaching a maximum by day 30 . Theophylline was withdrawn on day 4 and hepatic function normalised on day 45.

Two months after discharge, administration of IV theophylline for another asthma attack was accompanied by a rapid increase in AL T and GGT levels. Following theophylline withdrawal AL T returned to normal on day 30 and GGT on day 60. Hepatic biopsy specimens showed swollen hepatocytes , cytolysis and fat deposition . The patient was treated with ketotifen , sodium cromoglycate [cromolyn sodium] , {:l-mimetics and corticosteroids without event . Piperno D, Pacheco Y, Bastion Y, Faure-Monet PY, Gormand F, et at. Theophylline-Induced hepatit is . Two case report s. Therapie 43: 481 -483, Oct-Dec 1988 [Translated from the Original published in French] ..,.