Unmasking of Metamizole-induced Liver Injury by Simult aneous Development of Characteristic Agranulocytosis.
Metamizole
agranulocytosis
dipyrone
drug-induced hepatitis
drug-induced liver injury
liver
Journal
Current drug safety
ISSN: 2212-3911
Titre abrégé: Curr Drug Saf
Pays: United Arab Emirates
ID NLM: 101270895
Informations de publication
Date de publication:
2023
2023
Historique:
received:
02
12
2021
revised:
28
02
2022
accepted:
21
03
2022
medline:
1
6
2023
pubmed:
8
6
2022
entrez:
7
6
2022
Statut:
ppublish
Résumé
Metamizole is one of the most used analgesic, antipyretic, and spasmolytic agents in many countries worldwide. While metamizole-induced agranulocytosis is an, albeit seldom, well-known adverse event, metamizole-associated drug-induced liver injury has been reported rarely in the literature and hence often remains unconsidered. Here, we present a unique case where metamizole-induced hepatotoxicity got unmasked by the simultaneous development of characteristic agranulocytosis. A 22-year-old woman without known conditions presented with a new onset of fever, jaundice, and maculopapular rash and explicitly denied intake of any new substances. Laboratory tests showed liver injury, granulopenia, and positive anti-nuclear and anti-mitochondrial (AMA-M2) antibodies. Liver biopsy revealed a histological pattern characteristic of drug-induced liver injury and bone marrow biopsy, the classical picture of metamizole-induced agranulocytosis. Indeed the in-depth interview of the patient unveiled metamizole consumption over the last two months. Therefore, we could diagnose metamizole-induced hepato- and myelotoxicity. Accordingly, steroid therapy led to normalization of liver parameters and stimulation with granulocyte colony- stimulating factor to leukocyte recovery. This case report is intended to increase the awareness of metamizole-associated druginduced liver injury which should always be kept in mind due to its occasionally life-threatening course. Diagnosis can be difficult particularly if anamnesis and written records are without hints for prior metamizole intake.
Sections du résumé
BACKGROUND
BACKGROUND
Metamizole is one of the most used analgesic, antipyretic, and spasmolytic agents in many countries worldwide. While metamizole-induced agranulocytosis is an, albeit seldom, well-known adverse event, metamizole-associated drug-induced liver injury has been reported rarely in the literature and hence often remains unconsidered. Here, we present a unique case where metamizole-induced hepatotoxicity got unmasked by the simultaneous development of characteristic agranulocytosis.
CASE REPORT
METHODS
A 22-year-old woman without known conditions presented with a new onset of fever, jaundice, and maculopapular rash and explicitly denied intake of any new substances. Laboratory tests showed liver injury, granulopenia, and positive anti-nuclear and anti-mitochondrial (AMA-M2) antibodies. Liver biopsy revealed a histological pattern characteristic of drug-induced liver injury and bone marrow biopsy, the classical picture of metamizole-induced agranulocytosis. Indeed the in-depth interview of the patient unveiled metamizole consumption over the last two months. Therefore, we could diagnose metamizole-induced hepato- and myelotoxicity. Accordingly, steroid therapy led to normalization of liver parameters and stimulation with granulocyte colony- stimulating factor to leukocyte recovery.
CONCLUSION
CONCLUSIONS
This case report is intended to increase the awareness of metamizole-associated druginduced liver injury which should always be kept in mind due to its occasionally life-threatening course. Diagnosis can be difficult particularly if anamnesis and written records are without hints for prior metamizole intake.
Identifiants
pubmed: 35670337
pii: CDS-EPUB-124214
doi: 10.2174/1574886317666220606150721
doi:
Substances chimiques
Dipyrone
6429L0L52Y
Anti-Inflammatory Agents, Non-Steroidal
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
404-412Informations de copyright
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