Nachweis der allergischen Genese einer akuten Hepatitis durch den Lymphozytentransformationstest

Abstract

After accidental re-exposure to metamizole a 50-year-old patient developed severe jaundice within five hours (total bilirubin 43.9 mg/dl) with a rise of GOT to 147, of GPT to 222, of gamma-GT to 380 and of alkaline phosphatase to 497 U/l. The allergic genesis of this reaction was demonstrated in the lymphocyte transformation test which, in the presence of the causative substance and its metabolites, was performed five times during a period of 232 days. The first three tests were positive with stimulation indices up to 2.3. Sensitization to the metabolite 4-aminoantipyrine was demonstrated: this is known to be the first of four metabolites formed within 1-1 1/2 hours and constituting 40% of the four metabolites in the blood.

Acute Liver Failure in a Patient Treated With Metamizole

“…The reactive T cells are cytotoxic and can destroy keratinocytes and other cells, including hepatocytes and cholangiocytes. The patient described in the current report and the second patient with a positive lymphocyte transformation test described previously (Federmann et al, 1988) had no eosinophilia and/or exanthema, despite lymphocyte activation in the presence of metamizole. Obviously, in these two patients, the activated T cells only reacted against hepatocytes and possibly cholangiocytes, but not against keratinocytes.…”

“…There are currently two reports in the literature that metamizole can be hepatotoxic (Federmann et al, 1988; Herdeg et al, 2002). Similar to our findings, a positive lymphocyte transformation test was found in both patients described so far with metamizole-associated liver injury, suggesting a delayed hypersensitivity reaction with T-cell activation as a mechanism of hepatotoxicity.…”

“…Additional adverse reactions include allergic reactions manifesting as skin eruptions (Borja et al, 2003; Blanca-Lopez et al, 2016) or anaphylaxis with arterial hypotension (Garcia-Martin et al, 2015; Andrade et al, 2016). Liver injury has been reported (Federmann et al, 1988; Herdeg et al, 2002) but appears to be extremely rare. We report on a patient treated with metamizole who developed fulminant liver injury.…”

Carbamazepine‐induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: report of four cases and brief review

“…In Cases 1, 2, and 4, the initial symptoms of DRESS syndrome were fever and pharyngitis, which led to extensive investigations for an infectious disease and the administration of short courses of antipyretics and antibacterials that could, on their own, have caused the cutaneous or liver reactions (Table 4); however, the latency period was too long to consider a drug eruption induced by these medications, and the cutaneous involvement progressed despite their discontinuation. Only single reports of dipyrone‐induced hepatic damage have been described, 50,51 and acetaminophen liver toxicity has been attributed either to overdosage or prolonged use 52 . Only sulfamethoxazole/trimethoprim (Case 4) has been associated frequently with DRESS syndrome, 13 but, again, it had been introduced a few days after the onset of febrility.…”