TO THE EDITOR: Nonphenothiazine antipsychotic-induced hepatotoxicity is rare. 1,2 Risperidone is a nonphenothiazine benzisoxazole derivative that is structurally different from other antipsychotics associated with hepatotoxicity. Although hepatotoxicity is listed in the product information 3 as a potential adverse effect, there have been no reports of hepatotoxicity in patients receiving less than 25 days of therapy. To our knowledge, there are only two published letters 4,5 reporting possible risperidone-induced hepatotoxicity in adults. In the first report, 4 one patient had greater than 6 months' exposure, and a second patient had 6 weeks' exposure to risperidone 6 mg/d; both developed liver enzyme abnormalities consistent with hepatocellular toxicity. The second report 5 described a 54-year-old man with dementia who developed jaundice with an isolated increase in total bilirubin on day 25 after starting risperidone 1 mg bid. We describe suspected drug-induced hepatitis in a man who received only two doses of risperidone 0.5 mg po.Case Report. An 81-year-old white man was admitted to the hospital January 16, 1997, because of a history of paranoid delusions and a significant decline in his level of functioning. His medical history was significant for Parkinson's disease, dementia, depression, hypothyroidism, and peptic ulcer disease. He reported no history of alcoholism. Medications on admission included enteric-coated aspirin, diltiazem, sublingual nitroglycerin, levothyroxine, and doxepin. He had been taking stable dosages of all of these medications for at least 6 months; doxepin was not continued in the hospital. He was prescribed lorazepam prn on January 16, which he continued to receive throughout his hospital stay. Baseline liver function test results on admission were normal, with aspartate aminotransferase (AST) 20 units/L (normal <37), alanine aminotransferase (ALT) 13 units/L (<40), alkaline phosphatase 90 units/L (40-120), and total bilirubin 0.7 mg/dL (0.1-1.2). Risperidone was started on January 20. He received two doses of 0.5 mg po. On January 21, 1997, he was noted to be jaundiced and the risperidone was discontinued. Other than mild right upper quadrant pain, the patient reported no other symptoms. Similarly, physical examination revealed jaundice and some tenderness on palpation of the right upper quadrant. Liver function test results at that time revealed AST 434 units/L, ALT 101 units/L, total bilirubin 3.6 mg/dL, and alkaline phosphatase 244 units/L. Complete blood count, electrolytes, and serum creatinine were all normal. An ultrasound scan of the abdomen on January 22, 1997, revealed mild splenomegaly (14.1 cm) and small gallstones without any dilation of the biliary tree. Repeat liver function test results 2 weeks later (February 2, 1997) had returned to baseline (AST 19 units/L, ALT 5 units/L, alkaline phosphatase 114 units/L). Similarly, follow-up liver enzymes on April 17 and 24 were normal. Viral hepatitis serology (hepatitis A, B, and C) was negative. He continued to do well and re...

OBJECTIVE: To evaluate the prevalence of hepatitis C virus (HCV) genotypes in a central area of Italy (Umbria); to analyze the correspondence of the genotypes detected in serum and liver samples; to study the relationship between HCV genotypes and severity of liver disease; to test whether co-infection with more than one HCV subtype could be influenced by the source of infection. METHODS: Genotyping by polymerase chain reaction with core-specific primers (Okamoto method) was performed in the serum and liver from 48 consecutive patients with histologically confirmed chronic C hepatitis. RESULTS: HCV genotype 1b was the prevalent strain and was not associated with more severe histologic damage. Data show a very good correspondence between genotypes identified in serum and liver specimens (91%). Mixed infections (with subtypes 1b and 2a) correlated significantly with intravenous drug abuse (p=0.001). CONCLUSION: We confirmed that subtype 1b is prevalent in central Italy. Co-infection with more than one subtype is not rare in intravenous drug abusers.

In order to verify the relative role of each single risk factor during a long period of observation, and to compare the frequency of risk factors in parenterally and non-parenterally transmitted acute viral hepatitis, we studied 1,251 patients admitted to our Department from 1971 to 1991. Acute hepatitis A cases were considered non-parenterally transmitted, whereas B, C, NANB and Delta hepatitis were grouped together as parenterally transmitted. The two groups were compared for age, sex and the following risk factors: surgical procedures, transfusion, dental procedures, intravenous drug addiction, infected partner, infected relative and hospital admission. There were 243 non-parenterally transmitted and 1,008 parenterally transmitted cases. In univariate analysis, mean age in the two groups was 20 and 37 years (p = 0.000001) for non-parenterally and parenterally transmitted cases respectively; mean ages of patients with different parenterally transmitted hepatitis (B, NANB, C, Delta) did not differ significantly (p = 0.35). The following risk factors were significantly more frequent in the parenterally transmitted hepatitis group: surgical procedure (odds ratio = 8.04, 95% confidence intervals: 3.75, 20.51), transfusion (OR = 18.79, 95% CI: 5.03, 157.72), dental procedures (OR = 2.19, 95% CI: 1.2, 4.06), drug addiction (OR: 11.02, 95% CI: 4.15, 41.34), and infected partner (OR = 17.61, CI: 3.02, 708.65). However, logistic regression showed the following factors as being significant: age (p = 0.00001), transfusion (OR = 3.35, 95% CI: 1.61, 6.94), dental procedures (OR = 1.61, 95% CI: 1.18, 2.2), drug addiction (OR = 4.88, 95% CI: 2.94, 8.1).(ABSTRACT TRUNCATED AT 250 WORDS)