This patient appeared to develop a transient and self-limiting acute hepatitis-like injury after both famotidine and cimetidine therapy. The cross reactivity of these two agents was not suspected, based upon the lack of such cross reactivity to hepatic injury between cimetidine and ranitidine. However, in the case shown above, the recurrence was more rapid and perhaps slightly more severe with the “re-exposure” using cimetidine. Typical of H2 receptor blocker induced liver injury was the rapid recovery upon withdrawal. While liver biopsy was not done, in most such instances centrolobular necrosis with inflammation and mild cholestasis is found. This patient may have had mild underlying nonalcoholic fatty liver disease, but this is a common medical condition and probably did not play a role in the clinically apparent liver injury.
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