Hepatitis autoinmune inducida por drogas

Abstract

Drug-induced autoimmune hepatitis (DIAIH) is a specific phenotype that can lead to the devastating outcome of acute liver failure requiring liver transplantation. Drugs implicated in DIAIH include the antimicrobials amoxicillin-clavulanate, nonsteroidal anti-inflammatory drugs, statins, and antinecrotic agents. A typical clinical scenario supporting DIAIH (drug-induced autoimmune hepatitis) includes a history of drug exposure with spontaneous resolution of liver injury after drug withdrawal and absence of relapse after rapid steroid tapering. The present clinical case is of a 56-year-old male with a history of blunt injury to the right hand, treated with amoxicillin plus clavulanate and paracetamol. He was progressing with progressive jaundice of the skin and mucous membranes, dark urine, asthenia, and weakness. He was referred to the emergency department of the IGBJ Hospital in Cochabamba, where an altered liver function test was found, with an autoimmune profile with anti-smooth muscle antibodies (ASMA) and elevated IgG immunoglobulin. A liver biopsy was performed, which showed: chronic hepatitis with dense portal lymphoplasmacytic infiltrate, moderate interface hepatitis or necrosis (bite-out necrosis), mild periportal fibrosis, hepatocyte and canalicular cholestasis, and fibrosis: F0 (-) malignancy. A diagnosis of autoimmune hepatitis was made. Corticosteroid treatment was started with satisfactory clinical and laboratory results.