Indomethacin induced toxic hepatitis: a case report

Year 2022, , 139 - 142, 01.04.2022

Orkun Sakar , Tufan Teker Selim Giray Nak Nesrin Uğraş

https://doi.org/10.46310/tjim.1072846

Abstract

Nonsteroidal anti-inflammatory drugs deare widely used worldwide for analgesic, antipyretic and anti-inflammatory purposes. Indomethacin is a potent nonsteroidal anti-inflammatory drug and can cause severe liver damage. Few cases of idiosyncratic toxic hepatitis have been reported. Here, we present a case of indomethacin-induced toxic hepatitis that improved with methylprednisolone treatment.

Keywords

Drug induced liver injury, toxic hepatitis, Indomethacin

Supporting Institution

Bursa Uludag University Faculty of Medicine

Thanks

We thank our patient for allowing her data to be used in this scientific study.

References

• Huskisson EC, Taylor RT, Burston D, Chuter PJ, Hart FD. Evening indomethacin in the treatment of rheumatoid arthritis. Ann Rheum Dis. 1970 Jul;29(4):393-6. doi: 10.1136/ard.29.4.393.
• Carson JL, Strom BL, Duff A, Gupta A, Das K. Safety of nonsteroidal anti-inflammatory drugs with respect to acute liver disease. Arch Intern Med. 1993 Jun 14;153(11):1331-6.
• Cappell MS, Kozicky O, Competiello LS. Indomethacin- associated cholestasis. J Clin Gastroenterol. 1988 Aug;10(4):445- 7. doi: 10.1097/00004836-198808000-00019.
• Kelsey WM, Scharyj M. Fatal hepatitis probably due to indomethacin. JAMA. 1967 Feb 20;199(8):586-7. Fenech FF, Bannister WH, Grech JL. Hepatitis with biliverdinaemia in association with indomethacin therapy. Br Med J. 1967 Jul 15;3(5558):155-6. doi: 10.1136/bmj.3.5558.155.
• de Kraker-Sangster M, Bronkhorst FB, Brandt KH, Boersma JW. Massive liver cell necrosis following administration of indomethacin in combination with aminophenzone. Ned Tijdschr Geneeskd. 1981 Nov 7;125(45):1828-31 (in Dutch).
• Opolon P, Cartron J, Chicot D, Caroli J. Application of the lymphoblastic transformation test (LTT) to the diagnosis of drug-induced hepatitis. Presse Med. 1969 Dec 20;77(54):2041-4 (in French).
• Arıcı S. Toksik Hepatit. Pamukkale Tıp Dergisi. 2008;1(2):113-9.
• Castaldo ET, Chari RS. Liver transplantation for acute hepatic failure. HPB (Oxford). 2006;8(1):29-34. doi: 10.1080/13651820500465741.
• Danan G, Teschke R. RUCAM in drug and herb ınduced liver injury: The update. Int J Mol Sci. 2016;17(1):14. doi: 10.3390/ ijms17010014.
• Indomethacin. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. 2018 Mar 23.
• Andrade RJ, Lucena MI, Fernández MC, Pelaez G, Pachkoria K, García-Ruiz E, García-Muñoz B, González-Grande R, Pizarro A, Durán JA, Jiménez M, Rodrigo L, Romero-Gomez M, Navarro JM, Planas R, Costa J, Borras A, Soler A, Salmerón J, Martin-Vivaldi R; Spanish Group for the Study of Drug- Induced Liver Disease. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology. 2005 Aug;129(2):512-21. doi: 10.1016/j. gastro.2005.05.006.
• Björnsson E. Drug-induced liver injury: Hy’s rule revisited. Clin Pharmacol Ther. 2006 Jun;79(6):521-8. doi: 10.1016/j. clpt.2006.02.012.
• Reuben A. Hy’s law. Hepatology. 2004 Feb;39(2):574-8. doi: 10.1002/hep.20081.
• Andrade RJ, Chalasani N, Björnsson ES, Suzuki A, Kullak- Ublick GA, Watkins PB, Devarbhavi H, Merz M, Lucena MI, Kaplowitz N, Aithal GP. Drug-induced liver injury. Nat Rev Dis Primers. 2019 Aug 22;5(1):58. doi: 10.1038/s41572-019-0105-0