Phenobarbital‐Induced Liver Injury With Nodal Angiomatosis

Abstract

An 18‐year‐old woman presented with a 2‐week history of spiking fever after 3 weeks of daily use of phenobarbital, amoxicillin, chlorpheniramine, ergotamine, and cinnarizine for sinusitis and migraine. She denied animal contact as well as taking ethanol or supplements. Examination revealed enlarged nontender superficial lymph nodes (LNs) in her neck, a normal white blood cell count, atypical lymphocytes of 8.6%, aspartate aminotransferase of 288 U/L, alanine aminotransferase of 452 U/L, total bilirubin of 4.3 mg/dL, direct bilirubin of 3.6 mg/dL, gamma‐glutamyl transpeptidase of 469 U/L, alkaline phosphatase of 290 U/L, and lactate dehydrogenase of 619 U/L. Viral serology for hepatitis A, B, and C viruses, Epstein‐Barr virus, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus were all negative.

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