Propranolol-induced hallucinations mimicking encephalopathy in a patient with liver cirrhosis

Abstract

Hepatic encephalopathy (HE) is a frequent complication of liver cirrhosis, which is mostly characterized by psychomotor slowing. However, psychotic symptoms such as visual and olfactory hallucinations may sometimes also be present. In contrast, auditory hallucinations are uncommon in chronic liver disease. In this case report, we present a patient with liver cirrhosis due to excessive alcohol consumption who presented to the emergency department with disorientation and signs of infection. Initial assessment led to the diagnosis acute on chronic liver failure exacerbated by infection leading to encephalopathy. The patient was admitted and successfully treated with antibiotics, Lactulose and Rifaximin. Gastroscopy showed varices without bleeding stigmata and Propranolol 20 mg was initiated as primary prophylaxis. Upon follow-up, the patient was clinically stable but had developed visual and auditory hallucinations which raised the suspicion that HE was not the cause. CT scan of the brain was unremarkable and the hallucinations were considered to be caused by Propranolol and disappeared shortly after switching to Carvedilol.

Keywords:

• Hepatic encephalopathy
• hallucinations
• propranolol
• cirrhosis

Acknowledgment

We are thankful to our patient for allowing us to publish this case report. We are also thankful to the nurses at our hepatology outpatient clinic for their vigilance in noticing unusual symptoms of HE.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Informed consent

Informed consent was obtained from this patient prior to submission and the identity of the individual is fully anonymized.