Hepatic necrosis associated with drug-induced hypersensitivity syndrome

Ano: 2012 | Volume: 2 | Número: 4

Autores: F. P. F. Campos, P. P. Lima, L. Maragno, F. T. Watanabe

Palavras-chave: liver failure acute, massive hepatic necrosis, drug toxicity, autopsy.

Resumo Inglês:

Drug-induced hypersensitivity syndrome (DIHS; also known as drug reaction
with eosinophilia and systemic symptoms [DRESS]) is a life-threatening
condition first described by Chaiken et al. in 1950. It is characterized by extensive
mucocutaneous rash; fever; lymphadenopathy; hepatitis; hematological
abnormalities; damage to several organs such as kidney, heart, lungs, and
pancreas; and possible reactivation of human herpesvirus-6 (HHV-6) or other
herpes virus. Rare and severe cases may present hepatic necrosis, and about
15% of them result in death or liver transplantation. A hallmark of this syndrome
is the late onset of symptoms after the drug exposure. The most common
culprit drugs are the aromatic anticonvulsants (in almost 30% of the cases)
and the antibiotics (which in some series represent 20% of the cases). The
authors report a case of a 41-year-old female who presented to the emergency
department with erythroderma, acute hepatitis, acute pancreatitis and acute
renal failure, and was then treated with corticosteroid after the diagnosis of
DIHS/DRESS. A specific culprit drug could not confidently be determined due
to the presence of multiple drugs used by the patient. The clinical and laboratory
outcome was apparently satisfactory, but unexpectedly, on the sixth day of
hospitalization, the patient complained of nonspecific malaise, drowsiness,
which progressed in a few hours with signs and symptoms of hepatic failure,
refractory shock, and death. The autopsy findings showed submassive hepatic
necrosis, and the immediate cause of death was attributed to hepatic failure.