Severe hepatitis with prolonged cholestasis and bile duct injury due the long- term use of ornidazole

Nitroimidazole derivatives are commonly used in the treatment of protozoal and anaerobic infections, and reports of their hepato- toxicity are rare. We report a case of severe hepatitis due to the long-term (8 weeks) use of ornidazole. A 27-year-old woman pre- sented for evaluation of elevated serum transaminase and total bilirubin levels. Liver biopsy revealed portal inflammation, hepa- tocellular and canalicular cholestasis, porto-portal and porto- central bridging fibrosis, and a tendency to form nodules. No aetiological factors associated with chronic liver disease were iden- tified. The abdominal ultrasonographic findings were compatible with chronic liver disease. We therefore made the diagnosis of severe hepatitis resulting from the long-term use of ornidazole. We conclude that nitroimidazole derivatives may lead to serious liver damage, especially in female patients. (Acta gastroenterol. belg., 2007, 70, 293-295).