#36259 Naloxone infusion for the relief of cholestatic pruritus: presentation of a clinical case

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Background and Aims

Introduction Pruritus is a disabling, irritating sensation common to patients with variable skin and systemic disorders [1]. We describe the case of a young patient with disabling cholestatic pruritus, relived by infusion of naloxone.

Methods

Présentation of case A 34-year-old patient presents with sclerosing cholangitis symptoms that appeared 15 days after neurosurgery for atypical Grade II meningioma; requiring additional radiotherapy which was not done before the onset of cholestasis. initially attached to the phenobarbital prescribed postoperatively but it continued to progress relentlessly. MRI has objective Cholangitis, no inflammatory syndrome, normal Gamma globulins, negative hepatic autoimmune balance sheet. liver biopsy puncture: cholestasis without signs of inflammation, without granulomas. the pruritus is resistant to cholestyramine, ursolvan (at 25 mg/kg/d), and antihistamines. the patient presents with intense pruritus figures 1, 2, with repercussions on her quality of life. In the intensive care unit, she received a Naloxone infusion. Favorable evolution of the symptomatology and relief of the patient from the first hour of infusion without side effects during 48 hours spent in intensive care.

Results

Discussion A stepwise therapeutic approach is recommended for the management of cholestatic itch. Cholestyramine is considered first-line, followed by rifampin, naltrexone [2] The hypothesis that increased central opioidergic tone contributes to the pruritus of cholestasis justifies the treatment of this form of pruritus with opioid antagonists.

Conclusions

Naloxone has relieved the unpleasant sensation that leads to the urge to scratch from cholestatic pruritus, the symptomatic treatment of which is not very effective at the present time