scholarly journals Drug-induced Liver Injury Due to a Horse Chestnut Dietary Supplement

2021 ◽  
Author(s):  
Diogo Costa Santos ◽  
Graça Lérias ◽  
Isabel Madruga
Keyword(s):  
Liver Injury ◽  
Dietary Supplements ◽  
Venous Insufficiency ◽  
Acute Liver Injury ◽  
Western World ◽  
Horse Chestnut ◽  
Drug Induced ◽  
Common Cause ◽  
Drug Induced Liver Injury ◽  
Clinically Significant

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Western world. In recent years, natural herbal and dietary supplements have become widely available to the general public and have increased in popularity. Reports of idiosyncratic liver injury caused by such supplements have also increased over the last decade. Horse chestnut is a herb used in dietary supplements primarily for complications of venous insufficiency. Clinically significant acute liver injury has been very rarely associated with its use. We present the case of a 70-year-old man with idiosyncratic horse chestnut-induced liver injury.

scholarly journals Acetaminophen Test Battery (ATB): A Comprehensive Method to Study Acetaminophen-Induced Acute Liver Injury

2020 ◽  
Vol 20 (2) ◽  
pp. 125-138 ◽  
Author(s):  
Bharat Bhushan ◽  
Udayan Apte
Keyword(s):  
Liver Injury ◽  
Acute Liver Injury ◽  
Test Battery ◽  
Western World ◽  
Drug Induced ◽  
Technical Problems ◽  
Drug Induced Liver Injury ◽  
Comprehensive Method ◽  
Injury Models ◽  
Apap Hepatotoxicity

Acetaminophen (APAP) overdose is the major cause of acute liver failure (ALF) in the Western world. Extensive research is ongoing to identify the mechanisms of APAP-induced ALF. APAP-induced acute liver injury is also one of the most commonly studied drug-induced liver injury models in the field of hepatotoxicity. APAP toxicity is triphasic and includes three mechanistically interlinked but temporally distinct phases of initiation, progression, and recovery/regeneration. Despite how commonly it is studied, the methods to study APAP toxicity differ significantly, often leading to confusing and contradictory data. There are number of reviews on mechanisms of APAP toxicity, but a detailed mechanism-based comprehensive method and list of assays that covers all phases of APAP hepatotoxicity are missing. The goal of this review is to provide a standard protocol and guidelines to study APAP toxicity in mice including a test battery that can help investigators to comprehensively analyze APAP toxicity in the specific context of their hypothesis. Further, we will identify the major roadblocks and common technical problems that can significantly affect the results. This acetaminophen test battery (ATB) will be an excellent guide for scientists studying this most common and clinically relevant drug-induced liver injury and will also be helpful as a roadmap for hypothesis development to study novel mechanisms.

scholarly journals A Severe Case of Drug-Induced Liver Injury after Gemcitabine Administration: A Highly Probable Causality Grading as Assessed by the Updated RUCAM Diagnostic Scoring System

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ilenia Mascherona ◽  
Caterina Maggioli ◽  
Maira Biggiogero ◽  
Oreste Mora ◽  
Lucia Marelli
Keyword(s):  
Liver Injury ◽  
Hepatic Injury ◽  
Clinical Presentation ◽  
Acute Liver Injury ◽  
Severe Case ◽  
Suspected Drug ◽  
Serum Enzyme ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Clinically Significant

Gemcitabine is an antineoplastic drug used in several forms of advanced pancreatic, lung, breast, ovarian, and bladder cancer. Common side effects include bone marrow suppression, fatigue, diarrhea, nausea, gastrointestinal upset, rash, alopecia, and stomatitis. Transient serum enzyme elevations could be observed during therapy, but clinically significant acute liver injury has been rarely associated with its use. Few cases of acute liver injury have been reported in the literature. We reported the clinical case of a 73--year-old man who developed clinically significant acute hepatic injury after using gemcitabine. Possible causes, clinical presentation, and treatments are discussed. According to the updated RUCAM score, the case was rated 10 points and became a suspected drug-induced liver injury. Moreover, on the liver biopsy, there were histological findings of mild-to-moderate portal hepatitis, eosinophilia, bile duct injury, and mild perisinusoidal fibrosis, suggesting drug damage.

High-dose methotrexate-induced reversible grade 4 hyperbilirubinaemia and transaminitis in an adolescent with Burkitt Leukaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e237512
Author(s):  
Sanjeev Khera ◽  
Randhir Ranjan ◽  
Sateesh Ramachandran ◽  
Ajay Beriwal
Keyword(s):  
Liver Injury ◽  
Clinical Significance ◽  
Short Latency ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Drug Induced ◽  
Common Cause ◽  
Drug Induced Liver Injury ◽  
Dose Methotrexate

Symptomatic drug-induced liver injury (DILI) is an uncommon problem. Direct DILI is dose-related, predictable with short latency (hour to days) and is generally associated with transient and reversible transaminitis without jaundice. Antimetabolites including methotrexate are a common cause for direct DILI. Hepatotoxicity associated with high-dose methotrexate (HD-MTX) is generally transient and includes reversible elevation of transaminase in up to 60% and associated hyperbilirubinaemia (≤grade 2) in 25% of courses and therefore is of no clinical significance. Severe grades of DILI with HD-MTX (grade ≥4) are extremely rare. We describe an adolescent with Burkitt leukaemia who had reversible grade 4 DILI including hyperbilirubinaemia postfirst course of HD-MTX. Rechallenge with two-third dose of HD-MTX in subsequent chemotherapeutic cycle did not cause recurrence of DILI.

Unfavorable prognosis of patients with acute liver injury due to drug‐induced liver injury and acute exacerbation of hepatitis B virus infection

2019 ◽  
Vol 49 (11) ◽  
pp. 1286-1293 ◽  
Author(s):  
Keisuke Kakisaka ◽  
Yuji Suzuki ◽  
Yukina Jinnouchi ◽  
Jo Kanazawa ◽  
Tokio Sasaki ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Liver Injury ◽  
Virus Infection ◽  
Hepatitis B ◽  
Acute Exacerbation ◽  
Acute Liver Injury ◽  
Hepatitis B Virus Infection ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
B Virus

scholarly journals A Patient with Nafcillin-Associated Drug-Induced Liver Failure

2017 ◽  
Vol 11 (3) ◽  
pp. 564-568 ◽  
Author(s):  
Qin Rao ◽  
Isaiah Schuster ◽  
Talal Seoud ◽  
Kevin Zarrabi ◽  
Nirvani Goolsarran
Keyword(s):  
Liver Injury ◽  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Injury ◽  
Early Recognition ◽  
Antibiotic Use ◽  
Liver Function Tests ◽  
The United States ◽  
Drug Induced ◽  
Drug Induced Liver Injury

Nafcillin-induced acute liver injury is a rare and potentially fatal complication that has been known since the 1960s but inadequately studied. At this time, the only proven treatment is early discontinuation of the drug. Because of the high prevalence of nafcillin class antibiotic use in the United States, it is important for clinicians to have a high clinical suspicion for this diagnosis. We present a case of liver failure attributable to nafcillin use in a 68-year-old male with a history methicillin-sensitive Staphylococcus and L3/L4 osteomyelitis. After starting long-term antibiotic therapy, he presented with painless jaundice which necessitated discontinuation of the drug. At the time of presentation, the patient’s lab work exhibited a bilirubin/direct bilirubin of 9.4/8.2 mg/dL, alkaline phosphatase of 311 IU/L, and aspartate transaminase/alanine transaminase of 109/127 IU/L. The patient was switched to i.v. vancomycin given the concern for drug-induced liver injury. Imaging did not show obstruction of the hepatobiliary or pancreaticobiliary trees. Serology was unremarkable for viral etiology, autoimmune processes, Wilson disease, and hemochromatosis. A liver biopsy showed findings consistent with drug-induced liver injury. The patient’s liver function tests peaked at day 7 of admission and trended towards normal levels with cessation of nafcillin therapy. The patient was discharged with a diagnosis of nafcillin-induced acute liver injury. Our case highlights the importance of early recognition of the diagnosis and careful monitoring of liver function when nafcillin is employed in the clinical setting.

scholarly journals Correction: Cytokine profiles in acute liver injury—Results from the US Drug-Induced Liver Injury Network (DILIN) and the Acute Liver Failure Study Group

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0212394 ◽  
Author(s):  
Herbert L. Bonkovsky ◽  
Huiman X. Barnhart ◽  
David M. Foureau ◽  
Nury Steuerwald ◽  
William M. Lee ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Liver Injury ◽  
Study Group ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Cytokine Profiles ◽  
The Us

A Severe Case of Idiosyncratic Hepatotoxicity with Unfractionated Heparin

2020 ◽  
pp. 001857872096543 ◽  
Author(s):  
Jason Samuel Haney ◽  
Cassandra Tatum Carter ◽  
Jacklyn Downey ◽  
Romina Ilic
Keyword(s):  
Liver Injury ◽  
Unfractionated Heparin ◽  
Acute Liver Injury ◽  
Severe Case ◽  
Heart Catheterization ◽  
Severe Pulmonary Hypertension ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Left Heart Catheterization ◽  
Initial Injury

The authors describe a case of clinically apparent idiosyncratic hepatotoxicity in association with unfractionated heparin (UFH). A 52-year-old woman with increasingly symptomatic rheumatic mitral valvular disease and severe pulmonary hypertension underwent elective minimally-invasive bioprosthetic mitral valve replacement. The patient received 42 000 units of UFH intraoperatively 10 days after receiving 3100 units during a left heart catheterization. Standard prophylactic doses of unfractionated heparin were started on POD 2 for prevention of venous thromboembolism. On the evening of postoperative day (POD) 3, the patient was lethargic, encephalopathic, and hypoglycemic with an acute liver injury and hyperlactatemia. Similar events occurred on POD 7 after clinical improvement from the initial injury and an unintentional rechallenge with UFH. Heparins are usually not suspected of idiosyncratic hepatotoxicity due to their widespread utilization and reports of milder episodes of hepatotoxicity. This case highlights the need to consider UFH in the differential of drug-induced liver injury, including severe cases.

scholarly journals Diphenhydramine as a Cause of Drug-Induced Liver Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Yunseok Namn ◽  
Yecheskel Schneider ◽  
Isabelle H. Cui ◽  
Arun Jesudian
Keyword(s):  
Liver Injury ◽  
Acute Liver Injury ◽  
Chromosomal Translocation ◽  
Altered Mental Status ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Patient Reported ◽  
History Of ◽  
Concomitant Medications ◽  
Unites States

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Unites States and accounts for 10% of acute hepatitis cases. We report the only known case of diphenhydramine-induced acute liver injury in the absence of concomitant medications. A 28-year-old man with history of 13/14-chromosomal translocation presented with fevers, vomiting, and jaundice. Aspartate-aminotransferase and alanine-aminotransferase levels peaked above 20,000 IU/L and 5,000 IU/L, respectively. He developed coagulopathy but without altered mental status. Patient reported taking up to 400 mg diphenhydramine nightly, without concomitant acetaminophen, for insomnia. He denied taking other medications, supplements, antibiotics, and herbals. A thorough workup of liver injury ruled out viral hepatitis (including A, B, C, and E), autoimmune, toxic, ischemic, and metabolic etiologies including Wilson’s disease. A liver biopsy was consistent with DILI without evidence of iron or copper deposition. Diphenhydramine was determined to be the likely culprit. This is the first reported case of diphenhydramine-induced liver injury without concomitant use of acetaminophen.

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