Characteristics of liver injury in drug-induced systemic hypersensitivity reactions - 17/08/13
Abstract |
Background |
The liver is the most commonly involved internal organ in drug-induced systemic hypersensitivity. However, data obtained from these patients have yet to be analyzed in depth with respect to liver injury.
Methods |
The medical records of 136 patients who developed delayed-type drug hypersensitivity were reviewed at a tertiary referral hospital. Culprit drugs, the pattern and degree of liver injury, and the effect of systemic corticosteroids were evaluated in the group of patients with drug-induced systemic hypersensitivity and liver dysfunction (aspartate aminotransferase or alanine aminotransferase ≥80 IU/L). Clinical characteristics of patients with drug-induced systemic hypersensitivity and liver injury were analyzed.
Results |
Among the 61 patients with drug-induced systemic hypersensitivity and liver dysfunction, the clinical phenotypes were drug reaction with eosinophilia and systemic symptoms (n = 29, 48%), Stevens-Johnson syndrome/toxic epidermal necrolysis (n = 11, 18%), and maculopapular rash (n = 17, 28%). Antibiotics (n = 27, 44%) were the most common cause of drug-induced systemic hypersensitivity with liver dysfunction. Whereas patients with Stevens-Johnson syndrome/toxic epidermal necrolysis had mild hepatocellular-type liver injury of relatively brief duration, those with drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome had more severe and prolonged hepatocellular injury in addition to moderate to severe cholestatic-type liver injury. The use of systemic corticosteroids did not significantly affect either recovery from liver injury or mortality.
Limitations |
This study was retrospective and the number of subjects was small.
Conclusion |
The results suggest that the severity, pattern, and duration of liver injury differ according to the drug-hypersensitivity phenotype. Further studies are needed to evaluate the role of systemic corticosteroids in drug-induced systemic hypersensitivity and liver injury.
Le texte complet de cet article est disponible en PDF.Key words : corticosteroid, drug hypersensitivity, drug-induced liver injury
Abbreviations used : ADR, ALT, AST, DiHS, DRESS, SJS, TEN
Plan
Supported by a grant from the National Project for Personalized Genomic Medicine, Ministry for Health and Welfare, Republic of Korea (A111218-PG01). |
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Conflicts of interest: None declared. |
Vol 69 - N° 3
P. 407-415 - septembre 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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