Case report

A fatal case of bupropion (Zyban) hepatotoxicity with autoimmune features: Case report

Fawwaz Humayun¹ , Thomas M Shehab^1,2,5 , Joseph A Tworek³ and Robert J Fontana⁴

¹  Department of Internal Medicine, St. Joseph Mercy Health System, Ypsilanti, Michigan, 48197, USA

²  Section of Gastroenterology, St. Joseph Mercy Health System, Ypsilanti, Michigan, 48197, USA

³  Department of Pathology, St. Joseph Mercy Health System, Ypsilanti, Michigan, 48197, USA

⁴  Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA

⁵  Huron Gastro/Center for Digestive Care, Ypsilanti, Michigan, 48197, USA

author email corresponding author email

Journal of Medical Case Reports 2007, 1:88doi:10.1186/1752-1947-1-88

Published:	18 September 2007

Abstract

Background

Bupropion is approved for the treatment of mood disorders and as an adjuvant medication for smoking cessation. Bupropion is generally well tolerated and considered safe. Two randomized controlled trials of bupropion therapy for smoking cessation did not report any hepatic adverse events. However, there are three reports of severe but non-fatal bupropion hepatotoxicity published in the literature.

Case Presentation

We present the case of a 55-year old man who presented with jaundice and severe hepatic injury approximately 6 months after starting bupropion for smoking cessation. Laboratory evaluation demonstrated a mixed picture of hepatocellular injury and cholestasis. Liver biopsy demonstrated findings consistent with severe hepatotoxic injury due to drug induced liver injury. Laboratory testing was also notable for positive autoimmune markers. The patient initially had clinical improvement with steroid therapy but eventually died of infectious complications.

Conclusion

This report represents the first fatal report of bupropion related hepatotoxicity and the second case of bupropion related liver injury demonstrating autoimmune features. The common use of this medication for multiple indications makes it important for physicians to consider this medication as an etiologic agent in patients with otherwise unexplained hepatocellular jaundice.