Fatal cholestatic jaundice in elderly patients taking benoxaprofen.

All patients were women over the age of 80 years and were treated with benoxaprofen 600 mg daily. Case 1-An 86-year-old woman presented in January 1981 with a confusional state. She had a smooth firm liver palpable 6 cm below the costal margin, erythrocyte sedimentation rate of 75 mm in first hour, and a slightly raised alkaline phosphatase activity. She recovered spontaneously and was not seen until June 1981 when benoxaprofen was started for longstanding rheumatoid arthritis. Her final illness began in November 1981, when she developed progressive painless jaundice over two weeks. She deteriorated rapidly and died four days after admission to hospital with acute renal failure and rectal bleeding due to a coagulopathy (prothrombin time three times control value). Necropsy showed intrahepatic cholestatis and a mild inflammatory reaction in the portal triads. There was no evidence of extrahepatic bile duct obstruction or infective hepatitis. The kidneys showed tubular damage secondary to the hepatic dysfunction, with casts, blood, and bile thrombi. Case 2-An 82-year-old woman had a two-year history of confusion and difficulty in walking. She had had several falls and benoxaprofen.was started in June 1981 for back pain. In December 1981 she became anorectic and complained of vague abdominal pain. At the time of her admission to hospital in January 1982 she had jaundice and slight right hypochondrial tenderness. The jaundice deepened and she died of hepatorenal failure one week later. At necropsy the liver showed predominant centrilobular cholestasis with inspissated bile in the canaliculi. There was a mild chronic inflammatory infiltrate in the portal triads but no hepatitis. The kidneys were of normal size and showed acute tubular necrosis and the pancreas was acutely inflammed. The presentation and course of the final illness were similar in cases 3, 4, and 5; the table gives clinical details. In case 3 necropsy showed intrahepatic cholestasis and acute tubular necrosis.