Acute vanishing bile duct syndrome after the use of ibuprofen

Baştürk, Ahmet; Artan, Reha; Yılmaz, Aygen; Gelen, Mustafa Tekinalp; Duman, Özgür

doi:10.1016/j.ajg.2016.08.006

Cited by 17 publications

(14 citation statements)

References 14 publications

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“…Underlying liver diseases like hepatitis C may increase the risk of ibuprofen-induced acute liver injury [ 154 , 190 ]. Finally, Basturk et al [ 191 ] published a case report of a seven-year-old patient who developed toxic epidermal necrolysis and vanishing bile duct syndrome (VBDS) after oral ibuprofen intake. Acute VBDS is a rare disease with unknown etiology.…”

Section: Drug-induced Liver Injurymentioning

confidence: 99%

Natural Dietary Pigments: Potential Mediators against Hepatic Damage Induced by Over-The-Counter Non-Steroidal Anti-Inflammatory and Analgesic Drugs

et al. 2018

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Over-the-counter (OTC) analgesics are among the most widely prescribed and purchased drugs around the world. Most analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, are metabolized in the liver. The hepatocytes are responsible for drug metabolism and detoxification. Cytochrome P450 enzymes are phase I enzymes expressed mainly in hepatocytes and they account for ≈75% of the metabolism of clinically used drugs and other xenobiotics. These metabolic reactions eliminate potentially toxic compounds but, paradoxically, also result in the generation of toxic or carcinogenic metabolites. Cumulative or overdoses of OTC analgesic drugs can induce acute liver failure (ALF) either directly or indirectly after their biotransformation. ALF is the result of massive death of hepatocytes induced by oxidative stress. There is an increased interest in the use of natural dietary products as nutritional supplements and/or medications to prevent or cure many diseases. The therapeutic activity of natural products may be associated with their antioxidant capacity, although additional mechanisms may also play a role (e.g., anti-inflammatory actions). Dietary antioxidants such as flavonoids, betalains and carotenoids play a preventive role against OTC analgesics-induced ALF. In this review, we will summarize the pathobiology of OTC analgesic-induced ALF and the use of natural pigments in its prevention and therapy.

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Section: Drug-induced Liver Injurymentioning

confidence: 99%

Natural Dietary Pigments: Potential Mediators against Hepatic Damage Induced by Over-The-Counter Non-Steroidal Anti-Inflammatory and Analgesic Drugs

et al. 2018

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“…In a case recently reported by Bastuck et al VBDS occurred in a 7-year-old child who had toxic epidermal necrolysis after oral ibuprofen intake. However, the patient had a complete recovery within 8 months [ 6 ]. These reports suggested that ibuprofen can cause acute VBDS, and weight-based ursodeoxycholic acid was commonly used for VBDS with supportive care, although steroids, immunosuppressive agents, or plasmapheresis were provided occasionally [ 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although hyperlipidemia is an uncommon presentation in VBDS patients, it has been reported in a few pediatric patients. In the case presented by Basturk et al the child was treated with supportive care, an steroid, and ursodeoxycholic acid, with complete normalization of lipid profile in 8 months [ 6 ]. Another case reported by Cho et al was a 7-year-old boy with VBDS from trimethoprim-sulfamethoxazole combination therapy induced liver injury [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Vanishing bile duct syndrome with hyperlipidemia after ibuprofen therapy in an adult patient: a case report

et al. 2018

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BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed drugs and can cause drug-induced liver injury. Although patients with drug-induced liver injury from NSAIDs often recover spontaneously, 3% of them required hospitalization and those with persistent cholestasis present a diagnostic challenge. Recently, a few cases of children with persistent jaundice reported have been linked to the vanishing bile duct syndrome. However, data on adult patients is limited.Case presentationWe report herein a case of an adult patient who had persistent cholestasis with hyperlipidemia from the VBDS after ibuprofen use. We described a female patient with severe jaundice after taking ibuprofen, although she had no history of liver disease before. The drug-induced liver injury from ibuprofen was identified by clinical features and liver biopsy, which included the Roussel Uclaf Causality Assessment Method scores of 6 and pathological features of cholestasis with stage four drug-induced injury as well as loss of bile duct structures. The clinical course was featuring with persistently high levels of bilirubin associated with hyperlipidemia over the period of one month, although the laboratory abnormalities were slightly improved spontaneously after the cessation of ibuprofen. Her autoantibodies markers including AMA-M2 ASMA, RO-52, LKM, SLA, and anti-glycoprotein-210 were negative. The second liver biopsy was performed on day 213 due to persistent hyperbilirubinemia. Pathological findings were consistent with the diagnosis of vanishing bile duct syndrome.ConclusionsA rare case of ibuprofen-associated vanishing bile duct syndrome in an adult female patient is presented. Clinicians need to be aware of vanishing bile duct syndrome as a serious consequence of ibuprofen use in adult patients, although ibuprofen is considered to be among the safest NSAIDs.

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“…Seventeen published case reports and two case series of idiosyncratic ibuprofen-derived liver injury from 1976 to 2018 were retrieved, carefully analysed and summarised in Tables 2 and S1. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Of the 22 identified cases, 12 involved females (55%) and the mean patient age was 31 years (range 7 months-59 years). Thirteen patients (59%) had underlying chronic conditions, which were mainly Table S1).…”

Section: Demographic Characteristics Of Idiosyncratic Ibuprofen-indmentioning

confidence: 99%

“…15 Nevertheless, ibuprofen has been linked to instances of clinically apparent liver injury with injury patterns varying from moderate elevations of aminotransferases to vanishing bile duct syndrome (VBDS) and even acute liver failure (ALF) resulting in death. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] While most reported ibuprofen-induced hepatotoxicity cases to date are idiosyncratic, some cases of liver injury due to ibuprofen overdose have also been described. [35][36][37] The large consumption of ibuprofen worldwide together with the fact that only limited information is available on ibuprofen-induced hepatotoxicity to date, prompted us to look deeper into the phenotypic presentation of this type of DILI.…”

Section: Introductionmentioning

confidence: 99%

Systematic review: ibuprofen‐induced liver injury

Zoubek

Lucena

Andrade

et al. 2020

Aliment Pharmacol Ther

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Summary Background Nonsteroidal anti‐inflammatory drugs (NSAIDs) are a leading cause of drug‐induced liver injury (DILI) across the world. Ibuprofen is one of the most commonly used and safest NSAIDs, nevertheless reports on ibuprofen‐induced hepatotoxicity are available. Aim To analyse previously published information on ibuprofen‐induced liver injury for a better characterisation of its phenotypic expression. Method A systematic search was performed and information on ibuprofen‐induced liver injury included in case series and case reports, in terms of demographic, clinical, biochemical and outcome data, was analysed. Results Twenty‐two idiosyncratic ibuprofen hepatotoxicity cases were identified in the literature, suggesting a very low prevalence of this type of DILI. These patients had a mean age of 31 years and 55% were females. Mean cumulative dose of ibuprofen and time to onset were 30 g and 12 days, respectively. Hepatocellular injury was the most frequently involved liver injury pattern. Six cases developed vanishing bile duct syndrome. Full recovery occurred in 11 patients after a mean time of 14 weeks, whereas five cases evolved to acute liver failure leading to death/liver transplantation. Conclusions When assessing potential hepatotoxicity cases, physicians should keep in mind that ibuprofen has been associated with hepatotoxicity in the literature. Ibuprofen‐associated DILI presents commonly as hepatocellular damage after a short latency period. Published reports on ibuprofen hepatotoxicity leading to liver failure resulting in liver transplantation or death are available. However, due to the apparent low absolute risk of ibuprofen‐induced liver complications, ibuprofen can be regarded as an efficacious and safe NSAID.

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Acute vanishing bile duct syndrome after the use of ibuprofen

Cited by 17 publications

References 14 publications

Natural Dietary Pigments: Potential Mediators against Hepatic Damage Induced by Over-The-Counter Non-Steroidal Anti-Inflammatory and Analgesic Drugs

Natural Dietary Pigments: Potential Mediators against Hepatic Damage Induced by Over-The-Counter Non-Steroidal Anti-Inflammatory and Analgesic Drugs

Vanishing bile duct syndrome with hyperlipidemia after ibuprofen therapy in an adult patient: a case report

Systematic review: ibuprofen‐induced liver injury

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