- Email: [email protected]
Profile of DILI in Patients with Chronic Liver Disease
MISCELLANEOUS
Conclusion: Approximately 24% of patients with AIH have severe-AIH. Conventional autoantibodies are often absent in severe-AIH; however, it does not alter the outcome. Liver failure induced immune paralysis may mask the autoantibody production in severe-AIH. All the patients of severe AIH including Seronegative-AIH should be given a trial of corticosteroid based therapy early. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Nikhil Sonthalia. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.135
excluded. Antitubercular therapy (ATT) was implicated as definite DILI in 2 cases and probable in 1 case. Clarithromycin (6 cases), amoxicillin-clavulanate (4 cases) and clindamycin (4 cases) were most common antibiotics. 25 (69.4%) recovered, 8 (21.9%) expired, 2 (5.6%) developed acute on chronic liver failure and 1 (2.8%) underwent liver transplant. Conclusion: Definitive diagnosis of DILI in CLD patients is difficult. Exposure to a known hepatotoxic agent, temporal profile of LFT changes after initiation and withdrawal of antibiotics are useful pointers. Early diagnosis of DILI, even if not definitive, may help in timely intervention and affect outcomes in CLD patients. CONFLICTS OF INTEREST The authors have none to declare.
15
Corresponding author: Rajesh Gopalakrishna. E-mail: [email protected]
PROFILE OF DILI IN PATIENTS WITH CHRONIC LIVER DISEASE
http://dx.doi.org/10.1016/j.jceh.2016.06.136
Miscellaneous
S. Shiraz, Rajesh Gopalakrishna, C.M. Neethu, P. Nair, Rama Venu Amrita Institute of Medical Sciences, Kochi, India
Background and Aim: Patients with chronic liver disease (CLD) may be more susceptible to drug induced liver injury (DILI) via reduced drug clearance, aberrant metabolism, altered excretion, or impaired adaptive responses. Diagnosis of DILI may identify a reversible cause for acute decompensation. The aim of the study the profile and outcomes of DILI in CLD patients. Methods: 200 consecutive inpatients with CLD who had been received antibiotic therapy between September and December 2015 were prospectively studied for features suggestive of DILI. The Naranjo adverse drug reaction (ADR) probability scale was used for identifying ADRs in CLD patients. The Maria and Victorino (M&V) assessment scale was used for causality assessment. Results: Thirty-six (18%) patients were identified by Naranjo scale. The most common etiology of CLD in these patients was alcohol (50%); HCV (13.9%), NASH (8.3%), cryptogenic (8.3%), HBV (5.6%) were other common causes. DILI was more common in Child class C (58.3%) as compared to Child B (27.8%) and Child A (13.9%). 8 patients had hepatitic, 5 had cholestatic, and 23 had mixed pattern. By M&V scale, there were 2 definite, 8 probable, 11 possible cases of DILI while 12 were found to be unlikely and 3 were S82
16 HEPATORENAL FIBROCYSTIC DISEASE SPECTRUM IN 2 SISTERS Sajan Agarwal, Raj Gupta, Anu Bhandari, Kalpana Mangal J K Lone Hospital, SMS Medical College, Jaipur, Rajasthan, India
Background: Caroli’s syndrome (CS) is a rare congenital disorder characterized by multiple segmental cystic or saccular dilatations of the intrahepatic bile ducts and congenital hepatic fibrosis(CHF). The clinical features of this syndrome reflect both the characteristics of CHF such as hepatic fibrosis, portal hypertension, and renal cystic disease and that of Caroli’s disease (CD) named as recurrent cholangitis and cholelithiasis. CS is associated with renal involvement in up to 60% of patients and implies a dilatation of the collecting renal tubules. Case Report: We report a case of 2 sisters who were presented with hepatosplenomegaly, growth failure, intrahepatic bile duct dilatation and bilateral autosomal polycystic kidney disease (ARPKD) on imaging with histopathological diagnosis of CHF. To confirm this hepatorenal fibrocystic disease spectrum in younger sister, genetic testing (PKHD1 gene) was done and report is awaited. Elder sisters also had asymptomatic stage-2 chronic kidney disease © 2016, INASL
Conclusion: Approximately 24% of patients with AIH have severe-AIH. Conventional autoantibodies are often absent in severe-AIH; however, it does not alter the outcome. Liver failure induced immune paralysis may mask the autoantibody production in severe-AIH. All the patients of severe AIH including Seronegative-AIH should be given a trial of corticosteroid based therapy early. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Nikhil Sonthalia. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.135
excluded. Antitubercular therapy (ATT) was implicated as definite DILI in 2 cases and probable in 1 case. Clarithromycin (6 cases), amoxicillin-clavulanate (4 cases) and clindamycin (4 cases) were most common antibiotics. 25 (69.4%) recovered, 8 (21.9%) expired, 2 (5.6%) developed acute on chronic liver failure and 1 (2.8%) underwent liver transplant. Conclusion: Definitive diagnosis of DILI in CLD patients is difficult. Exposure to a known hepatotoxic agent, temporal profile of LFT changes after initiation and withdrawal of antibiotics are useful pointers. Early diagnosis of DILI, even if not definitive, may help in timely intervention and affect outcomes in CLD patients. CONFLICTS OF INTEREST The authors have none to declare.
15
Corresponding author: Rajesh Gopalakrishna. E-mail: [email protected]
PROFILE OF DILI IN PATIENTS WITH CHRONIC LIVER DISEASE
http://dx.doi.org/10.1016/j.jceh.2016.06.136
Miscellaneous
S. Shiraz, Rajesh Gopalakrishna, C.M. Neethu, P. Nair, Rama Venu Amrita Institute of Medical Sciences, Kochi, India
Background and Aim: Patients with chronic liver disease (CLD) may be more susceptible to drug induced liver injury (DILI) via reduced drug clearance, aberrant metabolism, altered excretion, or impaired adaptive responses. Diagnosis of DILI may identify a reversible cause for acute decompensation. The aim of the study the profile and outcomes of DILI in CLD patients. Methods: 200 consecutive inpatients with CLD who had been received antibiotic therapy between September and December 2015 were prospectively studied for features suggestive of DILI. The Naranjo adverse drug reaction (ADR) probability scale was used for identifying ADRs in CLD patients. The Maria and Victorino (M&V) assessment scale was used for causality assessment. Results: Thirty-six (18%) patients were identified by Naranjo scale. The most common etiology of CLD in these patients was alcohol (50%); HCV (13.9%), NASH (8.3%), cryptogenic (8.3%), HBV (5.6%) were other common causes. DILI was more common in Child class C (58.3%) as compared to Child B (27.8%) and Child A (13.9%). 8 patients had hepatitic, 5 had cholestatic, and 23 had mixed pattern. By M&V scale, there were 2 definite, 8 probable, 11 possible cases of DILI while 12 were found to be unlikely and 3 were S82
16 HEPATORENAL FIBROCYSTIC DISEASE SPECTRUM IN 2 SISTERS Sajan Agarwal, Raj Gupta, Anu Bhandari, Kalpana Mangal J K Lone Hospital, SMS Medical College, Jaipur, Rajasthan, India
Background: Caroli’s syndrome (CS) is a rare congenital disorder characterized by multiple segmental cystic or saccular dilatations of the intrahepatic bile ducts and congenital hepatic fibrosis(CHF). The clinical features of this syndrome reflect both the characteristics of CHF such as hepatic fibrosis, portal hypertension, and renal cystic disease and that of Caroli’s disease (CD) named as recurrent cholangitis and cholelithiasis. CS is associated with renal involvement in up to 60% of patients and implies a dilatation of the collecting renal tubules. Case Report: We report a case of 2 sisters who were presented with hepatosplenomegaly, growth failure, intrahepatic bile duct dilatation and bilateral autosomal polycystic kidney disease (ARPKD) on imaging with histopathological diagnosis of CHF. To confirm this hepatorenal fibrocystic disease spectrum in younger sister, genetic testing (PKHD1 gene) was done and report is awaited. Elder sisters also had asymptomatic stage-2 chronic kidney disease © 2016, INASL