Intrahepatic cholestasis caused by oral contraceptives with early onset (letter)

Oral contraceptives (OCs) may cause alterations of hepatic function due to the chemical structure of their estrogen fraction. Cholestasis is estimated to occur in 1 in 10000 OC users. Appearance of symptoms in the 1st 2 weeks of use is unusual. The case is described of a 31-year-old woman without previous hepatic disorder who developed generalized pruritus jaundice and other symptoms 1 week after beginning use of an OC containing ethinyl estradiol. Abdominal sonography showed hepatomegaly without parenchymatous alterations. A percutaneous hepatic biopsy under sonographic control demonstrated a simple cholestasis with little portal inflammatory infiltrate. The condition cleared up within 10 days after termination of OCs. Although early appearance of intrahepatic cholestasis has been linked to cholestasis of pregnancy the patient had no history of gestational cholestasis in 2 previous pregnancies. Intrahepatic cholestasis is characterized clinically by jaundice depigmentation of the stool conjugated hyperbilirubinemia elevation of the enzymes of cholestasis and mild hypertransaminasemia. The condition usually resolves without sequelae on termination of the OCs. This case demonstrates that intrahepatic cholestasis should not be ruled out in all OC users presenting jaundice or cholestasis no matter how briefly they have used the OC.