Nisan 2012
Montelukast kullanimina bagli akut fulminan seyirli hepatit vakasi
Montelukast-induced acute fulminant liver failure: A case report
- Ana Sayfa
- Sayılar
- Nisan 2012
- Montelukast kullanimina bagli akut fulminan seyirli hepatit vakasi...
Özet
Ilaca bagli karaciger hasari pek çok ilacin potansiyel bir komplikasyonu ve sik karsilasilan klinik bir tablodur. Literatürde montelukasta bagli karaciger enzim yüksekligi, hepatit ve fulminan hepatik yetmezlik nadir vaka bildirimleri seklindedir. Biz bu çalismada montelukast kullanimina bagli fulminan hepatik yetmezlikli vakamizi sunduk. Dirençli astim nedeni ile salbutamol inhaler, salmeterol+fluticasone inhaler ve 3 aydir montelukast sodyum kullanimi olan 42 yasinda bayan hasta son 1 haftadir olan ve giderek artan karin agrisi, sarilik ve bilinç bulanikligi sikayeti ile tarafimiza basvurdu. Klinik ve laboratuvar degerlendirmesi akut fulminan karaciger yetmezligi ile uyumlu olan hasta hepatoselüler hasara sebep olabilecek diger sebepler (enfeksiyöz, metabolik, otoimmün, ilaç v.b.) açisindan degerlendirildi. Karaciger biyopsisinde köprülesme nekrozu gösteren akut hepatit ile uyumlu bulgular saptandi, siroz bulgusu izlenmedi. Montelukast tedavisi kesildi. Hepatosellüler yetmezlige yönelik destek tedavisi baslandi. Montelukastin kesilmesinin 15. gününde hepatik yetmezlik tablosu düzelen ve karaciger fonksiyon testleri düzelme egilimine giren hasta taburcu edildi. Montelukastin kesilmesinin 50. gününde kontrole gelen hastanin karaciger fonksiyon testlerinde belirgin iyilesme oldugu görüldü. Montelukast sodyum kullanan hastalarda karaciger fonksiyon testlerinin izlenmesi ve bozukluk saptanmasi durumunda ilacin kesilerek hastanin uygun bir merkezde tedavi ve takibe yönlendirilmesi gerektigini düsünmekteyiz.
Abstract
Drug-induced liver injury is commonly encountered in general practice and a potential complication of many medications. Hepatotoxicity associated with montelukast-induced liver injury including elevated liver tests, hepatitis and fulminant liver failure has been described with rare case reports. We present the case of a 42-year-old woman with montelukast-induced fulminant liver failure. A 42-year-old woman had been taking salbutamol inhaler and salmeterol + fluticasone inhaler for five years and montelukast sodium for resistant asthma for three months, and was referred to our gastroenterology clinic with complaints of progressive abdominal pain, jaundice, and unconsciousness. We considered acute hepatic failure based on the laboratory and clinical findings. The patient was evaluated for other possible causes of hepatocellular damage (infectious, metabolic, autoimmune diseases, drugs, etc.). Liver biopsy was performed and revealed acute hepatitis with bridging necrosis, and there was no cirrhosis finding. Montelukast treatment was stopped, and supportive treatment was started for hepatocellular failure. Fifteen days after stopping montelukast, the liver function tests began to improve and symptoms of hepatic failure also diminished. She presented for follow-up 50 days after stopping montelukast, and liver function tests were confirmed as almost normal. We advise that periodic screening of liver function tests should be performed in patients taking montelukast. If any abnormality is detected, these patients should be referred to a center experienced in the treatment and follow-up of these patients.
