Nimesulide-induced fatal acute liver failure in an elderly woman with metastatic biliary adenocarcinoma. A case report

Bernardes, Sara Santos; Souza-Nogueira, André; Moreira, Estefânia Gastaldello; Kishima, Marina Okuyama; Guembarovski, Alda Fiorina Maria Losi; Turini, Tercílio Luiz; Turini, Conceição Aparecida

doi:10.1590/1516-3180.2013.7550003

Cited by 6 publications

(1 citation statement)

References 30 publications

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“…The nimesulide toxicity is due to mitochondrial dysfunction, with depletion of the enzyme's nicotinamide adenine dinucleotide phosphate and glutathione, occurring the increase of reactive oxygen species, calcium, and hepatic cell necrosis [17] . According to Bernardes et al [18] , nimesulide is frequently associated with hepatic lesions such as acute drug-induced hepatitis, which in the majority of cases occurs within therapeutic doses, thus, hepatotoxicity is associated with the formation of reactive metabolites that encode proteins, induce oxidative stress and mitochondrial injury.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Current Practices of Self-Medication among Students of the Biomedicine Degree at the Health Sciences School

Terezani

Cantarella

Simonato³

et al. 2020

Int J Innov Educ Res

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Self-medication is often seen as a solution for the immediate relief of symptoms, however, bringing serious consequences to consumer's health and serious public health problems in Brazil and the world. Still, regarding self-medication, the conduct of University students in the health area is observed, since the habit in this group is high. Given these facts and the need for epidemiological and toxicological evidence on self-medication of this school group, this study aims to verify the prevalence of self-medication in Biomedicine Degree students of the Universidade Brasil. It is a cross-sectional study conducted with 63 scholars from the first three graduation years of the Biomedicine degree at the Universidade Brasil, in Fernandópolis, São Paulo. A validated questionnaire with social and medication consumption variables was applied, followed by statistical analysis by the Mann-Whitney test. As a result, self-medication was considered an option for 59 of the participants, most of them juniors, female, aged between 18 and 20, with no previous college degree, with medical insurance and aware of possible health risks, even after access to classes or online surveys. The clinical condition preceding self-medication included mainly headache, myalgia, fever, and allergies. There was a preference for anthelmintic, anti-inflammatory, analgesic, antipyretic medication, mainly antibiotics, and central nervous system stimulants. The habit of self-medication increases, gradually, during the graduation period, therefore is suggested the implementation of an educational campaign in the Biomedicine course curriculum to undo this cycle of chemical substance consumption.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Current Practices of Self-Medication among Students of the Biomedicine Degree at the Health Sciences School

Terezani

Cantarella

Simonato³

et al. 2020

Int J Innov Educ Res

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Nimesulide

2015

Reactions Weekly

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S Nimesulide Renal damage and acute liver failure: case reportAn 81-year-old woman developed renal damage and fatal acute liver failure during treatment with nimesulide [therapeutic indication not stated]; the authors stated that liver cancer metastasis may also have contributed to the fatal acute liver failure.The woman, who had no hepatitis and adequate renal and hepatic function, presented with a 2-day history of haematemesis and epistaxis; she was hospitalised. She had ingested nimesulide at therapeutic doses once a day for 6 days [dosage not stated]. Three weeks earlier, she had taken diclofenac for 7 days; this drug had been stopped 4 days before the start of nimesulide. On admission, she had numerous diffuse haematomas, bilateral epistaxis, and melaena. She had hypotension (80 x 40 mmHg), a HR of 70 beats/min, a RR of 26 breaths/min and sudoresis. Laboratory tests revealed metabolic acidosis with respiratory alkalosis, and increased lactate. Her prothrombin time, partial thromboplastin time, fibrinogen level and platelet count were low.The woman received fresh frozen plasma and platelet transfusion. Her RBC, haemoglobin and haematocrit levels were diminished, with leucocytosis. The renal profile on admission showed increased urea and creatinine levels. Her AST was 10 times above normal and her ALT level was normal. Total and direct bilirubin levels were increased, but indirect bilirubin was normal. C-reactive protein was 30 times above normal. She underwent upper GI endoscopy to exclude GI bleeding; during the procedure, she developed respiratory arrest and decreased consciousness, requiring orotracheal intubation. Her renal and hepatic damage progressed 18 hours after admission, with higher levels of urea, creatinine, AST, ALT and bilirubins (including indirect bilirubin). At this time, γglutamyl transferase and alkaline phosphatase were highly elevated. Her haematological profile continued to worsen and, after 36 hours of hospitalisation, she underwent RBC, fresh frozen plasma and cryoprecipitate transfusion. Hepatitis B and C testing was negative. Carcinoembryonic antigen and CA-19-9 levels were increased by 1000-and 10 000-fold, respectively. CA-125 was increased 13-fold and alphafetoprotein levels were normal. Shortly after her transfusion, her general state worsened and she experienced a 12-minute cardiorespiratory arrest, with subsequent asystole and death.Necropsy showed liver acute hepatitis with inflammatory infiltrate, coagulative necrosis and hepatocellular collapse. Moreover, there was metastasis of moderately differentiated carcinoma, most likely from the bile duct.Author comment: "Although the patient had taken diclofenac three weeks before developing the clinical symptoms, we believe that nimesulide played a major role in her liver injury: first, because the patient was in the at-risk group; and second, because nimesulide was the current NSAID therapy. . . Although the patient was in the group at risk of [nimesulide]-induced hepatotoxicity, the liver cancer metastasis probably also contribu...

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Drug and herb-induced liver injury: A critical review of Brazilian cases with proposals for the improvement of causality assessment using RUCAM

Becker¹,

Lunardelli

Tovo³

et al. 2019

Annals of Hepatology

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Nimesulide-induced fatal acute liver failure in an elderly woman with metastatic biliary adenocarcinoma. A case report

Abstract: Despite the carcinoma presented by the patient, nimesulide use may have contributed towards the fatal acute liver failure. Until this issue has been clarified, caution is required in prescribing nimesulide for liver disease patients.

Cited by 6 publications

References 30 publications

Prevalence and Current Practices of Self-Medication among Students of the Biomedicine Degree at the Health Sciences School

Prevalence and Current Practices of Self-Medication among Students of the Biomedicine Degree at the Health Sciences School

Nimesulide

Drug and herb-induced liver injury: A critical review of Brazilian cases with proposals for the improvement of causality assessment using RUCAM

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