Alverine citrate is one of the most commonly used antispasmodic drugs for patients with irritable bowel syndrome. Alverine-citrate-induced hepatotoxicity is extremely rare, with only a few cases having been reported worldwide. We present a case of a 75-year-old female patient who experienced complicated jaundice and abdominal discomfort after taking alverine citrate. Other causes of hepatitis were ruled out and the results of the liver function test returned to normal after ceasing the drug. This is the first case report in Korea of alverine-citrate-induced hepatotoxicity.
Acute Disease ; Aged ; Citrates/*adverse effects/therapeutic use ; Drug-Induced Liver Injury/*diagnosis/etiology/pathology ; Female ; Humans ; Irritable Bowel Syndrome/drug therapy ; Liver Function Tests ; Parasympatholytics/*adverse effects/therapeutic use ; Propylamines/*adverse effects/therapeutic use ; Tomography, X-Ray Computed

INTRODUCTIONFew reports have documented allergic hypersensitivity reactions after barium gastrointestinal studies. Of these, the barium suspension, its additives or intravenous glucagon given for bowel relaxation has been implicated as possible allergens. We report a patient with delayed hypersensitivity reaction after barium enema and discuss the reasons supporting glucagon as the possible allergen.

CLINICAL PICTUREA 74-year-old Chinese woman presented with pruritic rashes, 1 day after a barium enema. Intravenous glucagon (GlucaGen, Novo Nordisk, Denmark) was administered during the barium enema. Physical examination revealed palpable purpuric rashes on the legs with erythematous papules and plaques on the arms and trunk. Skin biopsy demonstrated superficial perivascular infiltrates of lymphocytes and eosinophils, consistent with a drug eruption.

TREATMENT AND OUTCOMEThe rashes resolved with antihistamines and topical corticosteroids.

CONCLUSIONThis report highlights the potential of glucagon to cause hypersensitivity reactions. Awareness of this entity is important for the prevention and recognition of complications during barium gastrointestinal studies.

Adrenal Cortex Hormones ; therapeutic use ; Aged ; Barium Compounds ; Drug Hypersensitivity ; etiology ; Enema ; Female ; Glucagon ; administration & dosage ; adverse effects ; Histamine H1 Antagonists ; therapeutic use ; Humans ; Hypersensitivity, Delayed ; etiology ; Injections, Intravenous ; Parasympatholytics ; administration & dosage ; adverse effects ; Time Factors