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Canadian Journal of Gastroenterology
Volume 13, Issue 2, Pages 155-158
Brief Communication

Acute Pseudohepatitis in a Chronic Substance Abuser Secondary to Occult Seat Belt Injury

Eric CS Lam,1 Rhonda M Janzen,2 R Mark Meloche,2 Paul J Trepanier,3 and Eric M Yoshida1

1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
2Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
3Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada

Received 20 May 1998; Accepted 28 August 1998

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Causes of a massive elevation in serum aminotransferases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in the substance-abusing patient include viral hepatitis and drug hepatotoxicity. A patient chronically addicted to injection heroin and cocaine presented to the emergency room in a confused state and was admitted to a medical ward with an AST of 4120 U/L, ALT 3820 U/L and right upper quadrant discomfort. Investigations for viral and hepatotoxic causes for the liver dysfunction revealed only hepatitis C seropositivity. A computed tomogram of the abdomen, however, revealed a significant contusion to the right lobe of the liver consistent with traumatic injury. A motor vehicle accident, in which the patient was wearing a seat belt, and which had occurred a few days before admission and had been thought to be minor, was the cause of the liver dysfunction. Significant blunt abdominal traumatic injuries are usually managed exclusively by surgical trauma units. This case underlines the need for medical specialists to be aware of hepatic contusion injuries and to have a high index of suspicion when investigating unexplained hepatocellular dysfunction in chronic substance abusers who have been in motor vehicle accidents.