Romanian Journal of Morphology and Embryology 2007, 48(4):449–454 CASE REPORTS Drug-induced hepatitis – morphological and ultrastructural aspects AURELIA ENESCU 1) , P. MITRUŢ 2) , ELENA BUTEICĂ 3) , B. STĂNOIU 4) , ANCA ENESCU 5) 1) Medical Emergency Clinic 2) Internal Medicine Clinic 3) Genetics Department 4) Cellular and Molecular Biology Department 5) student University of Medicine and Pharmacy of Craiova Abstract Frequency of drug-induced liver diseases is increasingly, more than 200 different drugs being incriminated in hepatic disorders. We performed a retrospective study on 65 cases of deaths due to drug intoxications and an experimental model of subacute hepatitis induced by acetaminophen. In our experimental model, we observed various histological lesions: granular degeneration, vascular congestion, lymphoplasmocyte infiltration, cytonecrosis. Histological criteria are not specifically, but very usefully, because based on these criteria we can suspect a drug etiology in hepatic disorders when any other cause is absent. Ultrastructural study of hepatocytes revealed some modifications, in addition to data provided by optical microscopy. Keywords: drug-induced hepatitis, acetaminophen, ultrastructural study. Introduction Liver is the central organ not only for drugs metabolization, but also for toxic reactions [1]. All statistics from the last decade notice a marked increase of secondary drug – reactions, due to the huge number of drugs added to an impressive list of hepatotoxic drugs [2]. Hepatic reaction to some drugs depends on interactions between absorption, administration conditions and genetic factors. Importance of drug-induced hepatic lesions is a consequence of frequency and difficulties in differential diagnosis, and results also from pathological mechanism and clinical evolution [3]. Frequency of hepatic disorders drug-induced is definitely increasingly [4]. Women present a higher frequency than men and the maximum incidence is in patients after 40 years old. Moreover, the gravity of secondary drug – induced hepatic reactions increased as importance and about 14% are vitally [5]. More than 200 different drugs are incriminated in hepatic disorders. It is necessary especially a longer observation of drugs after commercialization, a regular report of secondary drug – reactions and a right information of the physician. Material and methods We performed: ▪ A retrospective study (between 2002–2007) on 65 cases dead by drug-induced intoxications, based on the data provided by Forensic Medicine Laboratory. ▪ An experimental model of acetaminophen-induced subacute toxic hepatitis, considering the large utilization of this drug, with or without medical prescription. The experimental protocol consists in administration of 1 ml dose of acetaminophen 3%, hypodermically inoculated to a group of 25 Wistar rats. The sacrifices have been done after 2, 3 and 4 weeks. Results We performed anatomo-pathological examination on 65 dead patients, 38 being women and 27 men. Distribution of cases on age periods was as the following: ▪ 0–30 years: 13 cases; ▪ 30–40 years: eight cases; ▪ 40–50 years: 18 cases; ▪ >50 years: 26 cases. Death occurred due to cardio-respiratory stop, acute hepato-renal insufficiency. We present some significant cases, focusing especially on microscopic aspect of the liver. Case no. 1 ▪ F. S., male, 43-years-old. ▪ Diagnosis: acute barbiturate intoxication. ▪ Anatomo-pathological examination: – liver: sinusoidal stasis, stasis in centrolobular vein;