CONTEXT: Angiotensin-converting enzyme inhibitors are prescribed for many @entity65 . Adverse hepatic events, especially @entity1448 , have rarely been reported with captopril, @entity4688 , @entity3593 , and @entity10959 . To date, @entity99 associated with @entity3372 has not been reported. OBJECTIVE: To describe 3 @entity1 who developed @entity99 , with or without @entity1087 , after receiving @entity3372 . DESIGN: Medical records and liver biopsies of the 3 @entity1 were reviewed. Clinical, laboratory, and histologic findings were compared with findings in other cases of angiotensin-converting enzyme inhibitor-induced @entity99 reported in the literature. RESULTS: The 3 @entity1 were middle-aged @entity1 . In 2 @entity1 , @entity1087 appeared 4 and 8 weeks after starting @entity3372 . @entity648 levels peaked at 15.5 and 5 mg/dL, and alkaline phosphatase values peaked at 957 and 507 U/L. Aminotransferase levels were mildly elevated. Endoscopic retrograde cholangiopancreatography and ultrasonography showed no bile duct obstruction. Liver biopsies from the @entity1087 @entity1 were similar, with @entity1448 , duct @entity39 , and extravasation of bile, ductular proliferation, and portal @entity32 . Cholestasis improved in 1 @entity1 6 weeks after stopping @entity3372 and was prolonged for 14 months in the other, in whom @entity2835 was present on biopsy. The third @entity1 developed @entity99 without @entity1087 3 weeks after starting @entity3372 ; symptoms resolved after stopping the drug. @entity3372 -associated @entity99 is similar to that seen with other angiotensin-converting enzyme inhibitors, but liver biopsy findings of duct @entity39 and extravasation of bile have not been reported previously. CONCLUSION: Prolonged @entity1448 and @entity2835 may result from the use of @entity3372 . Monitoring of liver enzymes is advisable for @entity1 starting on @entity3372 .

XXXX -associated hepatotoxicity.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'men'] @entity3372 :: ('MESH:D017257', 'Chemical') :: ['ramipril', 'Ramipril'] @entity4688 :: ('MESH:D004656', 'Chemical') :: ['enalapril'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammation'] @entity2835 :: ('MESH:D008105', 'Disease') :: ['biliary cirrhosis'] @entity1087 :: ('MESH:D007565', 'Disease') :: ['jaundice', 'jaundiced'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis'] @entity648 :: ('MESH:D001663', 'Chemical') :: ['Bilirubin'] @entity10959 :: ('MESH:D017328', 'Chemical') :: ['fosinopril'] @entity1448 :: ('MESH:D002779', 'Disease') :: ['cholestatic hepatitis', 'cholestasis'] @entity3593 :: ('MESH:D017706', 'Chemical') :: ['lisinopril'] @entity99 :: ('MESH:D056486', 'Disease') :: ['hepatic injury', 'liver injury', 'hepatitis'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cardiovascular and renal diseases']
@entity3372 :: (MESH:D017257,Chemical) :: ['Ramipril']
