Drug idiosyncrasy due to pirfenidone presenting as acute liver failure: Case report and mini‐review of the literature
نویسندگان
چکیده
Idiosyncratic drug-induced liver injury (DILI) is ranked among the top most common etiologies of acute liver failure (ALF). It carries poor transplant-free survival. Pirfenidone is an anti-inflammatory and antifibrotic drug that is commonly used for the treatment of idiopathic pulmonary fibrosis (IPF). Hepatotoxicity due to pirfenidone is rare and generally manifests as a mild rise in serum aminotransferases. In this mini-review, we report an unusual case of idiosyncratic DILI due to pirfenidone presenting as ALF, with emphasis on the definition, classification, diagnostic criteria, histopathology, molecular markers, and treatment options for DILI and related ALF. A 77-year-old man with known Parkinson's disease and IPF presented with jaundice for 7 days and altered mental status for 4 days. His long-term medications included a levodopa/carbidopa combination with a recent addition of pirfenidone over the previous 1 month; there was no monitoring of liver function tests. The evaluation suggested features of acute liver failure with grade III hepatic encephalopathy, acute kidney injury, and metabolic acidosis. The diagnostic workup ruled out viral, toxic, ischemic, and other etiologies for acute liver failure. Based on a Roussel Uclaf Causality Assessment Method score of 7 and possible DILI-ALF, pirfenidone was withdrawn. He was evaluated for liver transplantation but was declined. Despite all supportive measures in intensive care, organ failure progressed and he succumbed to the illness on day 4. Postmortem liver biopsy revealed findings consistent with DILI (final Roussel Uclaf Causality Assessment score, 10). Conclusion: DILI-ALF carries poor prognosis, and liver transplantation should be considered early in the course. Characterization, reporting, monitoring, and labeling of pirfenidone-related hepatotoxicity is vital given its common use in IPF. (Hepatology Communications 2018;2:142-147).
منابع مشابه
Orthotopic Liver Transplantation for Etanercept-Induced Acute Hepatic Failure; a case report
The occurrence of hepatotoxicity following etanercept (tumor necrosis factor-alpha antagonist) prescription, has been studied well. However, an acute hepatic failure leading to liver transplant as an adverse effect of this drug has not been reported in the literature. In this article, we are going to present a case of acute liver failure followed by liver transplantation, in a 32 years old man ...
متن کاملAcute Copper Sulfate Poisoning: Case Report and Review of Literature
Background: Copper sulfate ingestion is a relatively popular method for committing suicide in Indian subcontinent. It causes a high mortality rate, and so a growing concern has been raised to identify the severe alarming signs suggestive of poor prognosis and to improve treatment approaches. Case report: A 22-year-old unmarried man working as a painter was found unconscious at his friend reside...
متن کاملHeroin Body Packer’s Death in Shiraz, Iran; a Case Report and Literature Review
Background: Intra-corporeal concealment of illicit drugs known as ‘body packing’ is uncommonly reported. These drugs mainly comprise opium, heroin, cocaine, 3,4-methylenedioxymethamphetamine (ecstasy), amphetamines, and marijuana or hashish. Body packers may also be called swallowers, internal carriers, couriers or mules. Although this practice is not new, its medical complications have alway...
متن کاملRapid Death Due to Alcohol Withdrawal Syndrome: Case Report and Review of Literature
Background: Alcohol withdrawal syndrome (AWS) is one of the most serious complications associated with chronic alcoholism. Sudden deaths are not uncommon in AWS. In severe stages of AWS, delirium tremens (DT) occurs, which is characterized with agitation, global confusion, disorientation, visual and auditory hallucinations in addition to autonomic hyperactivity. Case report: A 30-year old man, ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 2 شماره
صفحات -
تاریخ انتشار 2018