Hypercalcemia worsened by the use of furosemide in a patient suffering from allopurinol-induced granulomatous hepatitis.

Granulomatous hepatitis is characterized by the appearance of fever and the finding of epiteliod granulomas in the liver of unknown aetiology. It can show itself as the first manifestation of a systemic disease. The clinical findings are scarce and related mostly to the basic pathology, fever being the most common of the initial symptoms, followed by constitutional syndrome, hepatomegaly and sometimes portal hypertension. Laboratory findings in the first stages include slight increases in hepatic enzymes and alkaline phosphatise. The aetiology for this picture encompasses different causes, form infection: bacterial (TB, Coxiella, Brucella), viral (CMV, EBV), adverse drug reactions (allopurinol, carbamazepine, halothane), to systemic pathology (Chron’s disease, sarcoidosis); the most frequent being TB, primary biliar cirrhosis and adverse drug reactions (1). We are presenting a case-study of one patient with granulomatous hepatitis secondary to treatment with allopurinol, aggravated by posterior addition of furosemide as treatment for hypercalcemia. A perusal of literature in PubMed (key words: allopurinol, granulomatous hepatitis), with no limits for date of publication or written language enabled us to find a meagre account for some ten published cases and only on case we found a coincidence for a clinical worsening when furosemide was concomitantly used with allopurinol in the course of the granulomatous hepatitis process.