Re: Antimitochondrial Antibodies

Posted By Steve on September 07, 1998 at 23:08:42:

In Reply to: Re: Antimitochondrial Antibodies posted by HFHSM.D.-D.M. on September 03, 1998 at 18:26:13:







:
"Have you heard of any drug-induced cases involving Antimitochondrial Antiboddies?
Many drugs can cause a form of immune-mediated hepatitis. I do not know of any specific drugs that give elevated AMA titers
but it is certainly possible that some do. Again, it might be interesting to see if your wife still has an elevated AMA when her
hives resolve completely."
We have been doing our research and found elevated AMAs caused by the following drugs:
anticonvulsive drugs - Watanabe K, et al, Nippon Shokakibyo Gakkai Zasshi 1998 Mar;95(3):246-249
clometacin (Duperan)- Pariente EA, et al, Gastroenterol Clin Biol 1989 Oct;13(10):769-774
clometacin, fenofibrate, oxyphenisatin and papaverine - Homberg JC, et al, Hepatology 1985 Sep;5(5):722-727
iproniazid - Danan G, et al, Gastroenterol Clin Biol 1983 May;7(5):529-532
anovlar - Yamamoto S, et al, Nippon Shokakibyo Gakkai Zasshi 1977 Nov;74(11):1561-1566
a vasculotropic drug, Venocuran or Venopyridum - Guardia J, et al, Nouv Presse Med 1977 Oct 1;6(32):2873-2875
As you suggested, in many of these cases if the drug was withdrawn in time, the AMAs and symptoms eventually went away.
This is our hope in my wife's case.  Do the above articles appear to you to be a sound basis for this hope?
I hope we have not become to technical for this forum.  Please advise.



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: Dear Steve:
I enjoyed your questions and I do not feel they are too technical for MEDHELP.  In fact, technical questions are ones that are often relatively straightforward for us to answer.  
I am impressed by the research you have done.  Unfortunately many of the articles to which you refer are in foreign language journals to which I do not have access.  There is one reference to Hepatology which is an outstanding journal but I am unable to easily access articles before 1988.  Because of this I cannot comment specifically on the articles.  
However, I think it is possible that medications can be associated with an elevation of the AMA and that the articles are a sound basis for hope.  I think it is possible that your wifes elevated AMA, elevated liver enzymes and hives could all be associated with a drug or environmental exposure that might improve with removal of the offending compound.   It would be interesting to know if your wife was on any medications in May.
I think it will be very interesting to see what happens to the liver enzymes and AMA over the next couple of months.  I still feel it is worthwhile for your wife to be seen be a liver specialist.
I hope this information is helpful to you. If you have additional questions or information, feel free to post the information back to me.  I find your wifes situation very interesting and I certainly hope she does well.  Again, you are always welcome to contact us directly at Henry Ford at [phone].
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  

[Steve__0__0]

Posted By Steve on August 23, 1998 at 23:46:51:
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Thank you for the followup.
We think you may have missed our followup dated 8/21/98.  We asked for a referral to an excellent hepatologist in the New York or Philadelphia area, and had a question on ultrasound results.
A reference touching on drug-induced AMAs that may be available to you is: Hepatology, A Textbook of Liver Disease, Volume II, Third Edition, by David Zakim and Thomas D. Boyer.  The Chapter on PBC has a good discussion of AMAs, and Table 44-5 on page 1336 shows the corresponding antigens for AMAs in drug-induced disorders.
Another reference you may have is from Liver, June 1997, 17(3): 119-128 by Klein R, et. al.
My wife wants to see a hepatologist ASAP (please suggest someone in our area) because of her latest lab results which are mixed:
Antimitochondrial Antibodies were at 1:160 titer on 8/3/98, and now (8/31/98) are up to >= 1:2560 titer but at a different lab.  We're hoping this is just a lab thing, but if the AMAs are going up we're scared.
Platelets were only 128 thous./cu.mm.
Prothrombin INR was borderline at 1.08 ratio.
The good news was that AST, ALT and GGT continue their steady decline since May 1998.  AST and ALT have reached normal levels at 32 IU/L each, and GGT is now down to 129 u/L.
Any assistance you can provide will be greatly appreciated.