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February 16, 2005

Cocaine-Induced Acute Hepatitis and Thrombotic Microangiopathy

JAMA. 2005;293(7):793-798. doi:10.1001/jama.293.7.797

To the Editor: Cocaine abuse has been separately associated with acute hepatitis and thrombotic microangiopathy (TMA); however, we are not aware of prior case reports of their simultaneous occurrence.

Report of a Case

A 22-year-old woman was hospitalized because of weakness, vomiting, fever, and jaundice for 3 days. She had consumed ethanol (80 g/d) and intravenous cocaine (1-2 g/wk) for the last 3 years but reported an increase in cocaine consumption in the previous week (>2 g/d). Chronic hepatitis C virus (HCV) was diagnosed 1 year earlier; at that time, her levels of transaminases, serum bilirubin, serum albumin, and her international normalized ratio (INR) were normal. On admission, physical examination was normal except for the presence of jaundice. She initially had markedly elevated transaminases (aspartate aminotransferase: 1264 U/L; alanine aminotransferase: 1305 U/L); increased alkaline phosphatase (308 U/L), γ-glutamyltransferase (110 U/L), and serum total bilirubin (12 mg/dL [205.2 μmol/L]); an albumin level of 34 g/L, INR of 1.10, and partial thromboplastin time of 33 seconds; and normal complete blood cell count and renal function. Urine toxicology screening was positive only for cocaine.

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