Cirrose hepática induzida por mesalazina: relato de caso / Mesalazine-induced hepatic cirrhosis: case report

Abstract

24 anos, sexo masculino, etilista social, estava em acompanhamento ambulatorial de Doença de Crohn desde dezembro de 2017, quando foi iniciado tratamento com mesalazina oral e corticóide com boa resposta clínica. Em consulta de rotina, cinco meses após início do tratamento, enzimas hepáticas encontravam-se Palavras-chave: Doença de Crohn, fibrose, cirrose hepática, 5 ácido aminosalicilato (5 ASA) ABSTRACT G.H.P.S, a 24-year-old male, social drinker, was in outpatient follow-up for Crohn's Disease since December 2017, when treatment with oral mesalazine and corticoid was initiated with good clinical response. At a routine visit, five months after treatment initiation, liver enzymes were elevated. From then on, propaedeutics was initiated in order to investigate the cause for such alteration. Two months later, the patient developed jaundice and persisted with increased serum levels of liver enzymes. Therefore, a druginduced liver injury was suspected and mesalazine was discontinued until clinical and laboratory improvement. However, after discontinuing the drug, the patient's symptoms of inflammatory bowel disease worsened and she resumed use of the medication on her own. After fifteen days, he began to experience hyporexia, prostration, and nausea associated with worsening jaundice, choluria, fecal acholia, and maintenance of altered liver enzymes. He suspected hepatitis, but the initial diagnostic workup did not identify the etiology. He opted for a liver biopsy that showed moderate fibrosis and cholestasis, possibly associated with drug injury. In view of this, the hypothesis of chronic hepatopathy secondary to mesalazine was confirmed.