Patients with drug-induced hepatocellular jaundice have 11.7% chance of progressing to death or transplantation. Amoxicillin-clavulanate stands out as the most common drug related to DILI.
Flutamide and cyproterone acetate (CPA) are both oral anti-androgens commonly used to treat advanced prostatic cancer. We report a case of drug-induced hepatotoxicity after consecutive treatment with flutamide and CPA. A 78-year-old male with advanced prostatic adenocarcinoma had been treated with flutamide 750 mg/day p.o. and leuproleride acetate 22.5 mg/3 months i.m. Three months later, the patient complained of choluria and jaundice. Laboratory examination revealed severe hepatocellular insufficiency. Flutamide-induced hepatotoxicity was suspected and therefore flutamide was withdrawn. His liver function abnormalities resolved after drug discontinuation. He was subsequently started on CPA 150 mg/day and again developed hepatotoxicity with severe hepatocellular impairment, which completely recovered after drug discontinuation. Other causes of acute liver failure were appropriately ruled out in both episodes and there was no evidence of active prostate cancer or liver metastases in both episodes. The occurrence of hepatotoxicity associated with flutamide and CPA on separated occasions suggests the possibility of a common mechanism of injury. It may become necessary to reassess the common practice of switching to another anti-androgen when hepatotoxicity appears. A closer monitoring of liver enzymes might be necessary in such cases, as an increased risk of a new severe hepatotoxicity event cannot be ruled out.
CorrespondenceNecrotising entercolitis. Increased incidence in infants receiving nasoduodenal feeding Sir, Beddis and McKenzie1 discussed the possible role of nasoduodenal feeding (NDF) in the aetiology of necrotising enterocolitis (NEC). They did not find a significantly higher incidence of NEC in their group of infants fed by NDF compared with those not being fed by NDF. We should like to report our observations. During a 2-year period (1978-9) we noticed an increased incidence of NEC. The total number of cases with NEC was 34, representing a rate of 0 94 per hundred admissions, which rose to a peak of 7 -5 during the last 5 months of the period. 77 matched control infants were chosen retrospectively among those of similar birthweights and dates of admission. The following factors were compared: birthweight, gestational age, 1-and 5-minute Apgar scores, highest haematocrit, type of formula fed, daily volume and caloric intake, and incidence of respiratory distress, persistent patent ductus arteriosus, mechanical ventilation, sepsis, exchange transfusion, and prevalence and time of indwelling umbilical catheters. No differences were found for any of these parameters between the two groups by Student's t test or the y 2 test. However, NDF had been used in 16 (470%) of the patients with NEC, and in 14 (18 %) of the matched
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.