Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis?
Introduction: Drug-induced liver injury (DILI) is one of the most common causes of liver damage. A large number of drugs, dietary supplements, and herbal medications can cause hepatotoxicity. In some situations, it is difficult to distinguish between DILI and autoimmune hepatitis, especially when t...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Journal of Infection in Developing Countries
2022-10-01
|
| Series: | Journal of Infection in Developing Countries |
| Subjects: | |
| Online Access: | https://jidc.org/index.php/journal/article/view/16594 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849313683079954432 |
|---|---|
| author | Nataša Dragutinović Aleksandra Barać Goran Stevanović Irena Đorđić Bianca Paglietti Jelena Micić Ema Aleksić Jelena Stojnić Jelena Martinov Nestorov |
| author_facet | Nataša Dragutinović Aleksandra Barać Goran Stevanović Irena Đorđić Bianca Paglietti Jelena Micić Ema Aleksić Jelena Stojnić Jelena Martinov Nestorov |
| author_sort | Nataša Dragutinović |
| collection | DOAJ |
| description |
Introduction: Drug-induced liver injury (DILI) is one of the most common causes of liver damage. A large number of drugs, dietary supplements, and herbal medications can cause hepatotoxicity. In some situations, it is difficult to distinguish between DILI and autoimmune hepatitis, especially when the mechanism is immune-mediated. Albendazole is a drug that has been used for decades for the treatment of parasitic infections in humans. One of the side effects is liver enzyme elevation, but rarely requires the discontinuation of therapy. Previous experience has shown that hypersensitivity is the most common mechanism of albendazole hepatotoxicity.
Case report: Here we presented a paediatric patient in whom albendazole induced severe liver injury. In laboratory analyses, in addition to markedly elevated transaminases and parameters of cholestasis, there was also a significant increase in IgG, so autoimmune hepatitis was considered. Even though the liver histology indicated toxic liver disease, prednisolone was started. Corticosteroid therapy resulted in the complete normalization of liver function, as well as IgG. With the cessation of corticosteroid therapy, transaminases, bilirubin and gamma-glutamyl transferase (GGT) remained within normal levels, but an increase in anti-smooth muscle antibodies (SMA) was noted in immunological analyses after one year of follow-up.
Conclusions: Immune-mediated hepatotoxicity from albendazole is one possible mechanism of liver injury. The use of albendazole in the treatment of parasitic infections, especially in children, requires close monitoring. The question remains as to whether albendazole is a drug that can induce autoimmune hepatitis in the paediatric population.
|
| format | Article |
| id | doaj-art-a676b3766f304343bfff650e12fcc1ab |
| institution | Kabale University |
| issn | 1972-2680 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | The Journal of Infection in Developing Countries |
| record_format | Article |
| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-a676b3766f304343bfff650e12fcc1ab2025-08-20T03:52:42ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802022-10-01161010.3855/jidc.16594Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis?Nataša Dragutinović0Aleksandra Barać1Goran Stevanović2Irena Đorđić3Bianca Paglietti4Jelena Micić5Ema Aleksić6Jelena Stojnić7Jelena Martinov Nestorov8Department of Gastroenterology, University Children’s Hospital, Belgrade, SerbiaClinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, SerbiaClinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, SerbiaDepartment of Gastroenterology, University Children’s Hospital, Belgrade, SerbiaDepartment of Biomedical Sciences, University of Sassari, Sassari, ItalyFaculty of Medicine, University of Belgrade, Belgrade, SerbiaFaculty of Stomatology, University Busines Academy in Novi Sad, Serbia, Pancevo, SerbiaFaculty of Medicine, University of Belgrade, Belgrade, SerbiaFaculty of Medicine, University of Belgrade, Belgrade, Serbia Introduction: Drug-induced liver injury (DILI) is one of the most common causes of liver damage. A large number of drugs, dietary supplements, and herbal medications can cause hepatotoxicity. In some situations, it is difficult to distinguish between DILI and autoimmune hepatitis, especially when the mechanism is immune-mediated. Albendazole is a drug that has been used for decades for the treatment of parasitic infections in humans. One of the side effects is liver enzyme elevation, but rarely requires the discontinuation of therapy. Previous experience has shown that hypersensitivity is the most common mechanism of albendazole hepatotoxicity. Case report: Here we presented a paediatric patient in whom albendazole induced severe liver injury. In laboratory analyses, in addition to markedly elevated transaminases and parameters of cholestasis, there was also a significant increase in IgG, so autoimmune hepatitis was considered. Even though the liver histology indicated toxic liver disease, prednisolone was started. Corticosteroid therapy resulted in the complete normalization of liver function, as well as IgG. With the cessation of corticosteroid therapy, transaminases, bilirubin and gamma-glutamyl transferase (GGT) remained within normal levels, but an increase in anti-smooth muscle antibodies (SMA) was noted in immunological analyses after one year of follow-up. Conclusions: Immune-mediated hepatotoxicity from albendazole is one possible mechanism of liver injury. The use of albendazole in the treatment of parasitic infections, especially in children, requires close monitoring. The question remains as to whether albendazole is a drug that can induce autoimmune hepatitis in the paediatric population. https://jidc.org/index.php/journal/article/view/16594Albendazolehepatotoxicitycholestasisimmune-mediatedautoimmune hepatitis |
| spellingShingle | Nataša Dragutinović Aleksandra Barać Goran Stevanović Irena Đorđić Bianca Paglietti Jelena Micić Ema Aleksić Jelena Stojnić Jelena Martinov Nestorov Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis? Journal of Infection in Developing Countries Albendazole hepatotoxicity cholestasis immune-mediated autoimmune hepatitis |
| title | Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis? |
| title_full | Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis? |
| title_fullStr | Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis? |
| title_full_unstemmed | Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis? |
| title_short | Acute hepatitis in a paediatric patient: immune-mediated drug-induced liver injury or albendazole-induced autoimmune hepatitis? |
| title_sort | acute hepatitis in a paediatric patient immune mediated drug induced liver injury or albendazole induced autoimmune hepatitis |
| topic | Albendazole hepatotoxicity cholestasis immune-mediated autoimmune hepatitis |
| url | https://jidc.org/index.php/journal/article/view/16594 |
| work_keys_str_mv | AT natasadragutinovic acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT aleksandrabarac acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT goranstevanovic acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT irenađorđic acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT biancapaglietti acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT jelenamicic acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT emaaleksic acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT jelenastojnic acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis AT jelenamartinovnestorov acutehepatitisinapaediatricpatientimmunemediateddruginducedliverinjuryoralbendazoleinducedautoimmunehepatitis |