Disulfiram-Induced Acute Liver Injury

Disulfiram is a drug used to treat alcohol dependence since many years. It interferes with the metabolism of alcohol, may be associated with neurological and dermatological symptoms, and can be hepatotoxic. Due to the frequent coexistent liver test alterations due to alcohol, the true incidence of disulfiram-associated liver injury is unclear and severity of injury may vary from mildly elevated liver enzymes to fulminant hepatitis leading to death. There are several reported cases of disulfiram hepatitis in the literature. Liver histology, when available, demonstrates some degree of portal inflammation with eosinophils and hepatocyte necrosis. We present here a well-documented case of acute hepatitis due to disulfiram with typical histological lesions, favorable outcome following drug withdrawal, and a brief steroid course. The risk of hepatotoxicity should be kept in mind when prescribing disulfiram.

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Rare Incidence of Acute Liver Injury with Potassium Para-Aminobenzoate Introduction

Case Reports in Gastroenterology ◽

10.1159/000488976 ◽

2018 ◽

Vol 12 (2) ◽

pp. 230-233 ◽

Cited By ~ 1

Author(s):

Layth Al Attar ◽

Wiliam Kilgore

Keyword(s):

Liver Injury ◽

Side Effect ◽

Liver Enzymes ◽

Acute Liver Injury ◽

Peyronie’S Disease ◽

Quadrant Pain ◽

Elevated Liver Enzymes ◽

Peyronie's Disease ◽

New Treatment ◽

The Many

Acute liver injury is an alarming condition, as it may lead to a devastating outcome. Of the many causes of acute liver injury, review of medications is crucial to identifying the cause of the injury. Some commonly used medications may unpredictably be the underlying cause of liver injury. We present a case of Peyronie’s disease treated with potassium para-aminobenzoate that developed acute liver injury. After starting the new treatment, the patient complained of right upper quadrant pain. He was found to have elevated liver enzymes. The condition resolved after stopping potassium para-aminobenzoate use. We report a potassium para-aminobenzoate side effect of liver injury that can be managed conservatively.

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Amiodarone-Induced Acute Liver Injury

Case Reports in Gastroenterology ◽

10.1159/000506184 ◽

2020 ◽

Vol 14 (1) ◽

pp. 87-90

Author(s):

Rajesh Essrani ◽

Shehriyar Mehershahi ◽

Rajesh Kumar Essrani ◽

Shri Jai Kirshan Ravi ◽

Sajeer Bhura ◽

...

Keyword(s):

Liver Injury ◽

Acute Hepatitis ◽

Injection Site ◽

Half Life ◽

Thyroid Dysfunction ◽

Liver Enzymes ◽

Acute Liver Injury ◽

Hepatic Toxicity ◽

Intravenous Amiodarone

Amiodarone is a lipophilic structure with a half-life of 25–100 days. Long-term oral amiodarone is associated with photosensitivity, thyroid dysfunction, and pulmonary and hepatic toxicity. Intravenous amiodarone can lead to sweating, heating sensation, nausea, phlebitis at the injection site, and rarely acute hepatitis. This is a compelling case of a 60-year-old male who developed acute liver injury 24–36 h after starting amiodarone. All the possible causes of acute liver injury were ruled out, and his liver enzymes improved after discontinuing amiodarone.

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A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

American Journal of Perinatology Reports ◽

10.1055/s-0039-1681028 ◽

2019 ◽

Vol 09 (01) ◽

pp. e84-e87

Author(s):

Jessica Morgan ◽

Micaela Della Torre ◽

Anna Whelan ◽

Sophia Rodriguez ◽

Laura DiGiovanni

Keyword(s):

Liver Enzymes ◽

Epigastric Pain ◽

Early Recognition ◽

Rare Complication ◽

Liver Function Tests ◽

True Incidence ◽

Hepatic Infarction ◽

Elevated Liver Enzymes ◽

Blood Pressures ◽

The Right

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.

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Traditional Chinese Medicine Prevents Inflammation in CCL4-Related Liver Injury in Mice

The American Journal of Chinese Medicine ◽

10.1142/s0192415x03000680 ◽

2003 ◽

Vol 31 (01) ◽

pp. 119-127 ◽

Cited By ~ 7

Author(s):

Y. M. Li ◽

P. Ryan ◽

R. G. Batey

Keyword(s):

Liver Injury ◽

Liver Enzymes ◽

Herbal Medicines ◽

High Dose ◽

Herbal Products ◽

Chinese Herbal ◽

Alternative Medicines ◽

Histological Damage ◽

Hepatocyte Necrosis ◽

Hepatic Histology

Alternative medicines are being increasingly used and investigated in the management of a variety of disorders. Hepatitis is a common indication for the use of alternative therapies but evidence for the efficacy of many compounds is lacking. We have utilized a well-defined model of liver injury to study the efficacy of three herbal products designed to assist in the management of liver disease. Mice were exposed to carbon tetrachloride (CCL4) given intragastrically after they had been pretreated for five days with either saline or one of four doses of silymarin extract or CH100 (a Chinese herbal medicine comprising of 19 herbs) or one of two doses of CH101 (a Chinese herbal preparation designed to reduce fibrosis). Animals were sacrificed 24 hours after receiving CCL4. Liver enzymes and hepatic histology formed the basis for evaluating efficacy of the treatments. Each of the alternative medicines reduced the alanine amino transferase (ALT) elevation demonstrated after CCL4 injection. The high dose CH100 regimen was most effective in protecting against injury and this was confirmed with hepatic histology. Other doses of CH100, CH101 and silymarin were not shown to provide protection against the histological damage. In conclusion, Silymarin, CH100 and CH101 are able to reduce ALT elevation in animals exposed to CCL4. High dose CH100 provides protection from hepatocyte necrosis in this model. The data add to our understanding of the capacity some herbal medicines have to modify the reaction of the liver to a variety of insults and suggest the value of studying these agents further in human liver diseases.

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Clozapine-induced liver injury and pleural effusion

Mental Illness ◽

10.1108/mi.2014.5403 ◽

2014 ◽

Vol 6 (2) ◽

pp. 36-37

Author(s):

Joseph P.M. Kane ◽

Francis A. O'Neill

Keyword(s):

Pleural Effusion ◽

Liver Injury ◽

Liver Enzymes ◽

Clinical Symptoms ◽

Acute Liver Injury ◽

Case Reports ◽

High Index ◽

Documented Case ◽

High Index Of Suspicion ◽

Symptoms And Signs

Clozapine, whilst associated commonly with a transient and benign increase in liver enzymes, has also been associated with varying presentations of hepatitis in existing case reports. This report describes what we believe to be the first documented case of acute liver injury and pleural effusion associated with clozapine, resolving after cessation of the agent. The case supports existing literature in advocating a high index of suspicion, particularly in the 4-5 weeks following clozapine initiation, when considering nonspecific clinical symptoms and signs.

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Anastrozole-induced liver injury after a prolonged latency: a very rare complication of a commonly prescribed medication

BMJ Case Reports ◽

10.1136/bcr-2019-231741 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231741 ◽

Cited By ~ 4

Author(s):

Chencheng Xie ◽

Hafez Mohammad Ammar Abdullah ◽

Mohamed Abdallah ◽

Erin Quist ◽

Mumtaz Niazi

Keyword(s):

Liver Injury ◽

Liver Enzymes ◽

Rare Complication ◽

Assessment Method ◽

Drug Induced ◽

Serious Adverse Events ◽

Drug Induced Liver Injury ◽

Elevated Liver Enzymes ◽

Safe Side ◽

Prolonged Latency

Anastrozole is an aromatase inhibitor that has been used more frequently over the last decade especially for oestrogen receptor-positive breast cancer. It has a relatively safe side effect profile. However, occasionally it has been associated with serious adverse events. Here, we present the case of a 58-year-old woman who presented with significantly elevated liver enzymes 4 years after starting anastrozole. She was not taking any other medications and an extensive workup did not reveal any other cause for her liver injury. The patient’s liver enzymes normalised after discounting the anastrozole. She scored 4 on the updated Roussel Uclaf Causality Assessment Method grading system which was possible for drug-induced liver injury. A review of the literature revealed six prior cases of anastrozole-related liver injury. Anastrozole should be considered as a possible culprit in patients who develop an unexplained acute liver injury.

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The Hepatoprotection by Oleanolic Acid Preconditioning: Focusing on PPARαActivation

PPAR Research ◽

10.1155/2018/3180396 ◽

2018 ◽

Vol 2018 ◽

pp. 1-14 ◽

Cited By ~ 8

Author(s):

Wenwen Wang ◽

Kan Chen ◽

Yujing Xia ◽

Wenhui Mo ◽

Fan Wang ◽

...

Keyword(s):

Liver Injury ◽

Oleanolic Acid ◽

Molecular Mechanisms ◽

Liver Enzymes ◽

Acute Liver Injury ◽

Inflammatory Factors ◽

Peroxisome Proliferator ◽

Peroxisome Proliferator Activated Receptor ◽

Anti Inflammatory ◽

Major Factors

Objective. Previous studies have characterized the hepatoprotective and anti-inflammatory properties of oleanolic acid (OA). This study aimed to investigate the molecular mechanisms of OA hepatoprotection in concanavalin A- (ConA-) induced acute liver injury.Materials and Methods. ConA (20 mg/kg) was intravenously injected to induce acute liver injury in Balb/C mice. OA pretreatment (20, 40, and 80 mg/kg) was administered subcutaneously once daily for 3 consecutive days prior to treatment with ConA; 2, 8, and 24 h after ConA injection, the levels of serum liver enzymes and the histopathology of major factors and inflammatory cytokines were determined.Results. OA reduced the release of serum liver enzymes and inflammatory factors and prevented ConA mediated damage to the liver. OA elevated the expression levels of peroxisome proliferator-activated receptor alpha (PPARα) and decreased the phosphorylation of c-Jun NH2-terminal kinase (JNK).Conclusion. OA exhibits anti-inflammatory properties during ConA-induced acute liver injury by attenuating apoptosis and autophagy through activation of PPARαand downregulation of JNK signaling.

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Liver Injury in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Measured by Diffusion-Weighted Magnetic Resonance Imaging

American Journal of Perinatology ◽

10.1055/s-0037-1613684 ◽

2017 ◽

Vol 35 (08) ◽

pp. 741-747

Author(s):

Ambereen Khan ◽

April Bailey ◽

Takeshi Yokoo ◽

Ivan Pedrosa ◽

Donald McIntire ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Liver Injury ◽

Hellp Syndrome ◽

Liver Enzymes ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Elevated Liver Enzymes ◽

Weighted Magnetic Resonance Imaging ◽

Adc Map

Objective The objective of this study was to evaluate acute liver injury (ALI) detected by diffusion-weighted magnetic resonance imaging (MRI) and the associated laboratory findings in women with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Study Design This was a retrospective, observational study of women with HELLP syndrome defined by serum aspartate aminotransferase (AST) levels ≥100 U/L and thrombocytopenia with platelets ≤100,000/µL. All women underwent MRI postpartum including diffusion-weighted imaging to estimate the volume of ALI with reconstructed apparent diffusion coefficient (ADC) maps. The ADC map and the volume of ALI were compared with laboratory abnormalities by Spearman's correlation analysis. Results From March 2013 through August 2015, 16 women with HELLP syndrome underwent MRI, and of these, 14 (88%) women had areas of increased signal intensity suggestive of ALI. Their median (range) maximum AST level was 262 (140–1,958) IU/L, and at the time of MRI, AST was 103 (36–1,426) IU/L. Both of these AST levels significantly correlated with ADC map as well as the volume of ALI (both p-values <0.001). Conclusion Women with HELLP syndrome frequently exhibited areas of abnormal diffusion in the liver on diffusion-weighted MRI, suggestive of ALI. The extent of liver injury was significantly correlated with serum AST.

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Direct or Collateral Liver Damage in SARS-CoV-2–Infected Patients

Seminars in Liver Disease ◽

10.1055/s-0040-1715108 ◽

2020 ◽

Vol 40 (03) ◽

pp. 321-330

Author(s):

Maria J. Lizardo-Thiebaud ◽

Eduardo Cervantes-Alvarez ◽

Nathaly Limon-de la Rosa ◽

Farid Tejeda-Dominguez ◽

Mildred Palacios-Jimenez ◽

...

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Liver Damage ◽

Cytopathic Effect ◽

Liver Enzymes ◽

Collateral Damage ◽

Viral Response ◽

Immune Mediated ◽

Vascular Congestion ◽

Elevated Liver Enzymes

AbstractLiver injury can result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with more than one-third of COVID-19 patients exhibiting elevated liver enzymes. Microvesicular steatosis, inflammation, vascular congestion, and thrombosis in the liver have been described in autopsy samples from COVID-19 patients. Several factors, including direct cytopathic effect of the virus, immune-mediated collateral damage, or an exacerbation of preexisting liver disease may contribute to liver pathology in COVID-19. Due to its immunological functions, the liver is an organ likely to participate in the viral response against SARS-CoV-2 and this may predispose it to injury. A better understanding of the mechanism contributing to liver injury is needed to develop and implement early measures to prevent serious liver damage in patients suffering from COVID-19. This review summarizes current reports of SARS-CoV-2 with an emphasis on how direct infection and subsequent severe inflammatory response may contribute to liver injury in patients with and without preexisting liver disease.

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