Drugs-induced liver injury associated with non-steroidal anti-inflammatory drugs: a case report and clinical insights

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Abstract

Aim: To raise the awareness of general practitioners with special characteristics of the clinical manifestations of the drug-induced liver injury (DILI), which can manifest with various signs, symptoms and types of morphological injury, from asymptomatic increase in transaminases and liver steatosis to chronic hepatitis with advanced fibrosis.
Key points: NSAID is one of the most commonly prescribed groups of agents worldwide. Most of them have low risk of liver toxicity. However, prolonged uncontrolled intake of NSAID by patients without proper medical follow-up and monitoring may lead to serious liver injury, illustrated by the clinical case presented. The case manifested as an extremely rare liver injury in the form of chronic hepatitis with advanced fibrosis that developed after prolonged NSAID use.
Conclusion: DILI usually occur as idiosyncratic (non-predictable) reactions. This is an exclusion diagnosis requiring comprehensive medical knowledge and awareness on potential drug-induced liver toxicity, including that associated with drug interactions. To minimize potential risk of liver toxicity induced by NSAID, it is recommended to take them in the lowest effective dose and for a minimally required period. A thorough assessment of a patient's past history, monitoring of clinical chemistry parameters, and clinical judgment of the physician remain to be decisive for prevention, timely diagnosis, and treatment of DILI.

About the authors

Yu. G. Sandler

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Author for correspondence.
Email: sandlerjulia2012@gmail.com
ORCID iD: 0000-0003-4291-812X

Yuliya G. Sandler – MD, PhD, Senior Researcher, Department of Hepatology

86 Shosse Entuziastov, Moscow, 111123

Россия

E. V. Vinnitskaya

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: e.vinnitskaya@mknc.ru
ORCID iD: 0000-0002-0344-8375

Elena V. Vinnitskaya – MD, PhD, Head of Department of Hepatology

86 Shosse Entuziastov, Moscow, 111123

Россия

K. G. Saliev

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru
ORCID iD: 0000-0002-4581-7052

Kirill G. Saliev – MD, Laboratory Researcher, Department of Hepatology

86 Shosse Entuziastov, Moscow, 111123

Россия

S. G. Khomeriki

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru
ORCID iD: 0000-0003-4308-8009

Sergey G. Khomeriki – MD, PhD, Professor, Head of Laboratory of Pathomorphology

86 Shosse Entuziastov, Moscow, 111123

Россия

T. Yu. Кhaimenova

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru
ORCID iD: 0000-0002-4599-4040

Tat'yana Yu. Khaymenova – MD, PhD, Head of Department of Liver Diseases

86 Shosse Entuziastov, Moscow, 111123

Россия

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Copyright (c) 2019 Sandler Y.G., Vinnitskaya E.V., Saliev K.G., Khomeriki S.G., Кhaimenova T.Y.

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