Hepatotoxicity induced by a second-generation combined oral contraceptive: case report and review of the literature

Abstract

Case: Second-generation combined oral contraceptives (COCs) are widely used and are believed to be safe for birth control and in the treatment of gynaecological diseases. No randomised controlled study has shown elevations in alanine transaminase (ALT) levels in relation to the use of a second-generation COC. We report a case of drug-induced liver injury (DILI) in a young, moderately obese woman, due to the use of a second-generation COC containing 30 µg ethinylestradiol and 150 µg levonorgestrel. COC use had been initiated 2 years prior to admission to our department. The diagnosis was based on elevated levels of ALT during COC use and was confirmed by re-challenge and a liver biopsy showing signs of former tissue damage after a 3 week break of COC treatment.

Conclusions: To our knowledge, this is the first case of biopsy-proven DILI due to COC use in which a re-challenge was performed.

摘要

病例报告：第二代复合口服避孕药（COC_S）的应用广泛, 在避孕及妇科疾病的治疗方面安全可靠。关于丙氨酸转氨酶（ALT）的升高与第二代COC之间的关系缺乏相关的随机对照研究。我们报告一例年轻中度肥胖女性由于第二代COC导致的药物性肝损伤（DILI）, 第二代COC含有30ug炔雌醇和150ug左炔诺孕酮。该患者来我们门诊之前就已经使用了COC 2年。该诊断是基于使用COC期间的ALT水平的升高, 并在停用COC三周再次使用COC后出现肝损伤并通过肝脏活检证实。结论：据我们所知, 这是第一例COC再次诱发肝损伤并通过肝脏活检证实的COC药物性肝损伤。

Keywords:

• Birth control
• drug-induced liver injury (DILI)
• ethinylestradiol
• levonorgestrel
• transaminase

Disclosure statement

The authors report no conflict of interest.