Autoimmune hepatitis following drug-induced liver injury in an elderly patient

Kumagai, Junichiro; Yasui, Shin; Haga, Yuki; Sasaki, Reina; Nakamura, Masato; Wu, Shuang; Nakamoto, Shingo; Arai, Makoto; Iino, Yotaro; Yokosuka, Osamu

doi:10.1007/s12328-016-0648-5

Cited by 11 publications

(14 citation statements)

References 21 publications

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“…In a second scenario, an episode of DILI/HDS triggers chronic AIH. This constellation has been proposed by case reports [ 55 ]. However, causality between drug intake and manifestation of chronic AIH cannot be proven thus far.…”

Section: Clinical Context Of Drug-induced Liver Injury and Hepaticmentioning

confidence: 89%

“Autoimmune(-Like)” Drug and Herb Induced Liver Injury: New Insights into Molecular Pathogenesis

Sebode

Schulz

Lohse

2017

IJMS

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Idiosyncratic drug-induced liver injury (DILI) and hepatic injury due to herbal and dietary supplements (HDS) can adapt clinical characteristics of autoimmune hepatitis (AIH), such as the appearance of autoantibodies and infiltration of the liver by immune competent cells. To describe these cases of DILI/HDS, the poorly-defined term “autoimmune(-like)” DILI/HDS came up. It is uncertain if these cases represent a subgroup of DILI/HDS with distinct pathomechanistic and prognostic features different from “classical” DILI/HDS. Besides, due to the overlap of clinical characteristics of “immune-mediated” DILI/HDS and AIH, both entities are not easy to differentiate. However, the demarcation is important, especially with regard to treatment: AIH requires long-term, mostly lifelong immunosuppression, whereas DILI/HDS does not. Only through exact diagnostic evaluation, exclusion of differential diagnoses and prolonged follow-up can the correct diagnosis reliably be made. Molecular mechanisms have not been analysed for the subgroup of “autoimmune(-like)” DILI/HDS yet. However, several pathogenetic checkpoints of DILI/HDS in general and AIH are shared. An analysis of these shared mechanisms might hint at relevant molecular processes of “autoimmune(-like)” DILI/HDS.

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Section: Clinical Context Of Drug-induced Liver Injury and Hepaticmentioning

confidence: 89%

“Autoimmune(-Like)” Drug and Herb Induced Liver Injury: New Insights into Molecular Pathogenesis

Sebode

Schulz

Lohse

2017

IJMS

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“…In this report, while possible, benzbromarone toxicity remains questionable, especially in light of the probable causal role of the co-administered camostat mesilate, which had demonstrated a positive lymphocyte stimulation test, in contrast to benzbromarone. However, it was not possible to entirely rule out benzbromarone [36].…”

Section: Discussionmentioning

confidence: 99%

“…In our literature review, we found no published reports on this topic in the Latin American databases Lilacs and SciELO. Our search found only one additional report, which was published in 2016 in Japan [36]. A total of 11 cases of hepatotoxicity related to benzbromarone were reported by the Periodic Safety Update Report (PSUR) between 1995 and 2000.…”

Section: Safety Evidencementioning

confidence: 99%

“…Furthermore, studies have shown an incidence of approximately 3% for urolithiasis in patients treated with benzbromarone 75-120 mg/d or a median dose of 100 mg/day [15,19]. The 5 published reported cases include 2 deaths related to fulminant hepatitis, one case of fulminant hepatitis with response to steroid treatment, one case of hepatotoxicity responsive to withdrawal and one case of auto-immune hepatitis in which benzbromarone was co-administered with camostat mesilate [32][33][34][35][36].…”

Section: Studies Evaluating Benzbromarone's Safetymentioning

confidence: 99%

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Benzbromarone in the treatment of gout

Azevedo

Kos²,

Vargas-Santos

et al. 2019

Adv Rheumatol

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Background: Benzbromarone is a uricosuric drug that has been used in the treatment of gout over the last 30 years. Due to its potent inhibition of the dominant apical (luminal) urate exchanger in the human proximal tubule URAT1, it reduces the urate reabsorption, diminishing serum urate levels and therefore preventing gout flares. Main body of the abstract: Through several clinical trials, Benzbromarone has been proved effective and safe, inclusive in patients with chronic kidney disease and as combination therapy with allopurinol. Due to hepatotoxicity reports, it was withdrawn from the European market by the manufacturer, however many authors have questioned the product's withdrawal due to a lack of clinical evidence in order to support its hepatotoxicity. Benzbromarone is still available in several European countries, New Zealand, Brazil and several other countries. Despite the product's marketing over more than 20 years after the first hepatotoxicity reports, we have found only five reports in our literature search, and no prospective or retrospective study correlating hepatotoxicity with benzbromarone use. Short conclusion: Benzbromarone is a safe and effective molecule for the treatment of gout. However, due to in vitro and in vivo data related to hepatotoxicity, it is prudent to prescribe it with some caution, especially for patients with an already known liver condition.

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“…Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are representative autoimmune liver diseases [ 4 , 5 ]. AIH possesses a chronic active hepatitis histologically with autoimmune features and poor prognosis without immune suppressive therapies [ 4 , 6 ]. PBC is diagnosed based on the presence of an antimitochondrial antibody (AMA), elevated cholestatic liver enzyme and/or histologically by chronic non-suppurative destructive cholangitis (CNSDC) [ 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Interferon-free treatment for patients with chronic hepatitis C and autoimmune liver disease: higher SVR rates with special precautions for deterioration of autoimmune hepatitis

et al. 2018

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BackgroundInterferon-free treatment can achieve higher sustained virological response (SVR) rates, even in patients in whom hepatitis C virus (HCV) could not be eradicated in the interferon treatment era. Immune restoration in the liver is occasionally associated with HCV infection. We examined the safety and effects of interferon-free regimens on HCV patients with autoimmune liver diseases.ResultsAll 7 HCV patients with autoimmune hepatitis (AIH) completed treatment and achieved SVR. Three patients took prednisolone (PSL) at baseline, and 3 did not take PSL during interferon-free treatment. In one HCV patient with AIH and cirrhosis, PSL were not administered at baseline, but she needed to take 40 mg/day PSL at week 8 for liver dysfunction. She also complained back pain and was diagnosed with vasospastic angina by coronary angiography at week 11. However, she completed interferon-free treatment. All 5 HCV patients with primary biliary cholangitis (PBC) completed treatment and achieved SVR. Three of these HCV patients with PBC were treated with UDCA during interferon-free treatment.ConclusionsInterferon-free regimens could result in higher SVR rates in HCV patients with autoimmune liver diseases. As interferon-free treatment for HCV may have an effect on hepatic immunity and activity of the autoimmune liver diseases, careful attention should be paid to unexpected adverse events in their treatments.MethodsTotal 12 patients with HCV and autoimmune liver diseases [7 AIH and PBC], who were treated with interferon-free regimens, were retrospectively analyzed.

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Autoimmune hepatitis following drug-induced liver injury in an elderly patient

Cited by 11 publications

References 21 publications

“Autoimmune(-Like)” Drug and Herb Induced Liver Injury: New Insights into Molecular Pathogenesis

“Autoimmune(-Like)” Drug and Herb Induced Liver Injury: New Insights into Molecular Pathogenesis

Benzbromarone in the treatment of gout

Interferon-free treatment for patients with chronic hepatitis C and autoimmune liver disease: higher SVR rates with special precautions for deterioration of autoimmune hepatitis

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