Do we treat patients or do we poison them?

Introduction: The polypragmastic drug intake of multimorbid patients need special attention due to common drug interactions and the potential occurence of organ damages. In this case study, we present a severe toxic hepatitis developed as the result of taking normal, recommended levels of multiple medications. Case study: A 62-year old man presented with a medical history of only occassional alcohol consumption, hypertension, diabetes mellitus, diffuse liver lesions and traumatic pneumothorax. Previously in 2008, he was also treated with angina pectoris when he already showed the initial signs of impaired liver functions. Two months later, he was admitted to our department in a frail health state with fever and icterus. Liver function tests showed extremely elevated transaminase levels and abnormal levels of obstructive enzymes. The clinical picture suggested acute hepatitis. Further tests excluded viral origin, while abdominal ultrasound did not show any morphological abnormality. Based on these results and knowing that two months earlier his metformin+glimepirid+atorvastatin therapy was supplemented with pioglitazone, we assumed a drug induced hepatitis in the background. After discontinuing his statin and replacing his oral antidiabetic drugs with insulin treatment, his complaints stopped and his liver functions returned close to normal. Discussion: Patients who take potentially hepatotoxic drugs and show the signs of impaired liver function need very strict control. After the initiation of antilipidaemic drugs, follow-up is compulsory in one month. Although in this case, a control check of the liver functions was suggested two weeks after the original alteration of the patient's medications, this was missed due to the ignorance of the patient and his general practitioner.