First case of ivermectin-induced severe hepatitis

Abstract

Summary Loiasis, caused by the filarial parasite Loa loa, is endemic in West and Central Africa. Ivermectin has been shown to be an effective treatment of loiasis. We report the case of a 20-year-old woman originally from Cameroon who was infected by the L. loa parasite and developed severe hepatitis, identified 1 month after a single dose of ivermectin. Liver biopsy showed intralobular inflammatory infiltrates, confluent necrosis and apoptosis, compatible with drug-induced liver disease. To our knowledge, this is the first case of ivermectin-induced severe liver disease published in the literature. © 2006 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. Case reportIn October 2000, a 20-year-old woman was referred to the Swiss Tropical Institute, Basle, Switzerland, for evaluation of a migrating worm in the sclera of her right eye ( Figure 1). She reported general body itching over several years, headache and dizziness. She had lived in Cameroon until the age of 15; she had moved to Switzerland 5 years previously and had not visited Africa since then. She had had meningitis with subsequent persistent deafness and a history of hepatitis A and B. Initial physical examination was inconspicuous except for moderate abdominal pain.The worm that was removed from the patient's right eye was identified as an adult Loa loa, with a length of 2 cm. Initial L. loa microfilaraemia was 820/ml of whole * Corresponding author. blood. There was an eosinophilia of 18.5% (absolute count 350/l), and liver enzymes were normal. The patient was treated with albendazole (600 mg/d) for 21 d. One month after the end of therapy, the microfilaraemia dropped to 250/ml and was still at this level 3 months thereafter (Table 1). Clinical signs and liver enzymes remained normal, and no abdominal pain was reported. A single dose of 15 mg (300 g/kg) ivermectin, a dosage previously reported as having no major side effects (Kombila et al., 1998), was given to reduce the microfilaraemia further. At a routine follow-up 1 month after administration of ivermectin, the patient reported moderate new diffuse abdominal pain. Physical examination showed a new tenderness in the upper right quadrant; the liver was not enlarged. Laboratory investigation revealed elevated liver enzymes: ALAT 907 IU/l (normal range 7-42), ASAT 279 IU/l (normal range 5-39) and ␥GT 66 IU/l (normal range 8-78); bilirubin, alkaline phosphatase, C-reactive protein, and red and white blood cell counts were in the normal range. Viral hepatitides were ruled out by means of serology (HAV, HBV, HCV, CMV, EBV).

Effect of high‐fat meal intake on the pharmacokinetic profile of ivermectin in Japanese patients with scabies

“…observed hepatic dysfunction with increases of AST and ALT values after a single administration of Stromectol in a patient with scabies under fasted states. It was also reported that an 85‐year‐old patient with scabies taking IVM under the fasted state developed hepatic dysfunction after the second administration . Of course, HF meal intake does not always cause hepatic dysfunction to patients taking IVM.…”

“…It was also reported that an 85-year-old patient with scabies taking IVM under the fasted state developed hepatic dysfunction after the second administration. 16 Of course, HF meal intake does not always cause hepatic dysfunction to patients taking IVM. However, those cases in the present study and previous reports suggest that it is especially important to perform blood biochemical tests for elderly patients after IVM administration.…”

Identification and Characterization of Cefazolin-Induced Liver Injury

“…Reports of delayed DILI after a single intravenous dose of medication are rare, but have been reported sporadically 26 . A search of the FDA Adverse Event Reporting system (http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/) failed to reveal a report of DILI after a single intravenous dose of medication.…”

DNA damage kinetics and apoptosis in ivermectin‐treated chinese hamster ovary cells

“…Our results are in concordance with our previous observations of decreasing cell viability, the delay of cell‐cycle progression and a concomitant reduction of the proliferative rate index in IVM‐ and IVO‐treated CHO‐K1 cells (Molinari et al ., ). Furthermore, the results extend previous observations indicating the ability of IVM to induce confluent necrosis and apoptosis, compatible with drug‐induced human liver disease (Veit et al ., ).…”