Investigation of Inherited Chromosomally Integrated Human Herpesvirus-6A+ and -6B+ in a Patient with Ulipristal Acetate-Induced Fulminant Hepatic Failure

Inherited chromosomally integrated (ici) human herpes virus 6 (HHV-6) is estimated to occur in 0.6–2.7% of people worldwide. HHV-6 comprises two distinct species: HHV-6A and HHV-6B. Both HHV-6A and HHV-6B integration have been reported. Several drugs are capable of activating iciHHV-6 in tissues, the consequences of which are poorly understood. We report herein a case of a woman with iciHHV-6A+ and iciHHV-6B+, who developed ulipristal acetate (a selective progesterone receptor modulator)-induced fulminant hepatic failure that required liver transplantation. We confirmed the presence of ~one copy per cell of both HHV-6A and HHV-6B DNA in her hair follicles using multiplex HHV-6A/B real-time PCR and demonstrated the Mendelian inheritance of both iciHHV-6A and iciHHV-6B in her family members over three generations. Because of the rarity of this presentation, we discuss herein the possible links between reactivated HHV-6 from iciHHV-6A and/or iciHHV-6B and adverse drug reactions, suggesting that iciHHV-6 could be screened before the introduction of any hepatotoxic drugs to exclude HHV-6 active disease or combined idiosyncratic drug-induced liver injury in these patients.

Download Full-text

Faculty Opinions recommendation of Gap junction inhibition prevents drug-induced liver toxicity and fulminant hepatic failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717955250.793460400 ◽

2012 ◽

Author(s):

Ralf Weiskirchen

Keyword(s):

Gap Junction ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Liver Toxicity ◽

Drug Induced ◽

Gap Junction Inhibition

Download Full-text

Oxaprozin-Induced Fulminant Hepatitis

Annals of Pharmacotherapy ◽

10.1177/106002809402801004 ◽

1994 ◽

Vol 28 (10) ◽

pp. 1159-1161 ◽

Cited By ~ 16

Author(s):

Preston P. Purdum ◽

Stacey L. Shelden ◽

John W. Boyd ◽

Mitchell L. Shiffman

Keyword(s):

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Fulminant Hepatitis ◽

The Elderly ◽

Nonsteroidal Antiinflammatory Drugs ◽

Antiinflammatory Drugs ◽

Drug Induced ◽

Hepatic Transaminase ◽

Long Acting ◽

Work Up

OBJECTIVE: To report oxaprozin-induced fulminant hepatic failure. CASE SUMMARY: A 56-year-old woman was admitted with fulminant hepatic failure. Work-up for potential etiologies was negative except for the use of oxaprozin for the preceding two months. Results of premortem liver biopsy were consistent with drug-induced hepatic injury similar to that previously reported with diclofenac. DISCUSSION: Although the literature describes elevation in hepatic transaminase concentrations associated with oxaprozin, fulminant hepatic failure has not been described previously. CONCLUSIONS: Elevations in hepatic transaminase concentrations and now fulminant hepatic failure have been shown to occur with oxaprozin, as previously seen with other nonsteroidal antiinflammatory drugs (NSAIDs). Transaminitis is a known adverse effect of NSAID use, but is usually mild and reversible with discontinuation of drug. Transaminitis may be more likely to occur in the elderly, in patients receiving concurrent potentially hepatotoxic medications, and possibly with the newer long-acting NSAIDs. The existence of fulminant hepatitis, although rare, supports the need for monitoring liver function enzymes during NSAID therapy.

Download Full-text

Gap junction inhibition prevents drug-induced liver toxicity and fulminant hepatic failure

Nature Biotechnology ◽

10.1038/nbt.2089 ◽

2012 ◽

Vol 30 (2) ◽

pp. 179-183 ◽

Cited By ~ 78

Author(s):

Suraj J Patel ◽

Jack M Milwid ◽

Kevin R King ◽

Stefan Bohr ◽

Arvin Iracheta-Vellve ◽

...

Keyword(s):

Gap Junction ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Liver Toxicity ◽

Drug Induced ◽

Gap Junction Inhibition

Download Full-text

Human herpesvirus 6 fulminant hepatic failure treated by living donor liver transplantation

Pediatrics International ◽

10.1111/j.1442-200x.2004.01989.x ◽

2004 ◽

Vol 46 (6) ◽

pp. 730-732 ◽

Cited By ~ 7

Author(s):

Masahiro Ohashi ◽

Tetsushi Yoshikawa ◽

Katsuhiro Asonuma ◽

Takuya Iwasaki ◽

Yukihiro Nishiyama ◽

...

Keyword(s):

Liver Transplantation ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Human Herpesvirus ◽

Human Herpesvirus 6 ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Herpesvirus 6

Download Full-text

Levofloxacin-Induced Acute Fulminant Hepatic Failure in a Patient with Chronic Hepatitis B Infection

Annals of Pharmacotherapy ◽

10.1345/aph.1g111 ◽

2005 ◽

Vol 39 (10) ◽

pp. 1737-1740 ◽

Cited By ~ 22

Author(s):

şahin Çoban ◽

Bilge Ceydilek ◽

Fuat Ekiz ◽

Esra Erden ◽

İrfan Soykan

Keyword(s):

Hepatitis B ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Hepatitis B Surface Antigen ◽

Drug Induced ◽

Upper Respiratory Infection ◽

Negative Results ◽

B Virus ◽

Short Time ◽

The Relationship

OBJECTIVE: To report a case of possible levofloxacin-induced acute fulminant hepatic failure. CASE SUMMARY: An unconscious 55-year-old woman was hospitalized with the diagnosis of hepatic encephalopathy. The patient had received levofloxacin 500 mg daily for 10 days because of an upper respiratory infection. Her past medical history revealed hepatitis B surface antigen positivity as an asymptomatic hepatitis B virus carrier for 10 years. After hospitalization, treatment included plasmapheresis and supportive care. The patient's consciousness improved on the second day of treatment. Other etiologies of fulminant hepatic failure were ruled out, suggesting levofloxacin-induced fulminant hepatic failure. Although the patient received supportive treatment, her condition gradually deteriorated and she died 12 weeks after admission to our hospital. An objective causality assessment revealed that the adverse event was possibly related to levofloxacin. DISCUSSION: Levofloxacin is widely used because of its broad spectrum of antimicrobial activity. As of August 9, 2005, to our knowledge, only one case of fulminant hepatic failure in relation to levofloxacin has previously been published. We believe that, in our patient, the relationship between levofloxacin and her illness is clear because of the negative results in the etiological studies, the short time between the drug's administration and the development of disease, and the pathologic findings suggestive of drug-induced hepatitis. CONCLUSIONS: Clinicians should be aware of the possibility of severe hepatic injury associated with levofloxacin when prescribing this drug.

Download Full-text

Erratum: Gap junction inhibition prevents drug-induced liver toxicity and fulminant hepatic failure

Nature Biotechnology ◽

10.1038/nbt0314-291c ◽

2014 ◽

Vol 32 (3) ◽

pp. 291-291 ◽

Cited By ~ 1

Author(s):

Suraj J Patel ◽

Jack M Milwid ◽

Kevin R King ◽

Stefan Bohr ◽

Arvin Iracheta-Velle ◽

...

Keyword(s):

Gap Junction ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Liver Toxicity ◽

Drug Induced ◽

Gap Junction Inhibition

Download Full-text

Fulminant hepatic failure attributed to infection with human herpesvirus 6 (HHV-6) in an immunocompetent woman: A case report and review of the literature

Journal of Clinical Virology ◽

10.1016/j.jcv.2015.12.002 ◽

2016 ◽

Vol 75 ◽

pp. 27-32 ◽

Cited By ~ 8

Author(s):

Angella Charnot-Katsikas ◽

David Baewer ◽

Linda Cook ◽

Michael Z. David

Keyword(s):

Case Report ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Human Herpesvirus ◽

Review Of The Literature ◽

Human Herpesvirus 6 ◽

Herpesvirus 6

Download Full-text

EXTRACORPOREAL LIVER ASSIST FOR PIGS WITH DRUG INDUCED FULMINANT HEPATIC FAILURE USING A PACKED-BED TYPE BIO-ARTIFICIAL LIVER

ASAIO Journal ◽

10.1097/00002480-200303000-00275 ◽

2003 ◽

Vol 49 (2) ◽

pp. 210

Author(s):

K Yanagi ◽

N Umamoto ◽

N Ohshima

Keyword(s):

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Packed Bed ◽

Artificial Liver ◽

Drug Induced

Download Full-text

Drug-induced fulminant hepatic failure in pregnancy

Obstetric Medicine ◽

10.1177/1753495x15598909 ◽

2015 ◽

Vol 8 (4) ◽

pp. 190-192 ◽

Cited By ~ 3

Author(s):

Tabassum Firoz ◽

Douglas Webber ◽

Hilary Rowe

Keyword(s):

Liver Disease ◽

Liver Failure ◽

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Liver Enzymes ◽

Abnormal Liver Function ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Elevated Liver Enzymes ◽

In Pregnancy

Liver disease in pregnancy can be classified as predating, co-incidental or unique to pregnancy. Medications are often overlooked as a significant cause of liver disease. We present the case of a 39-year-old patient who presented at 20 weeks with jaundice, elevated liver enzymes, and abnormal liver function progressing eventually to fulminant hepatic failure. The patient was on methyldopa and labetalol from 12 weeks’ gestational age. Liver biopsy was consistent with drug-induced liver injury. Both methyldopa and labetalol have been associated with hepatotoxicity including liver failure. This case highlights the importance of including medications as a cause of liver failure in pregnant patients.

Download Full-text