Rodrigo L, de Francisco R, Pérez-Pariente J M, Cadahia V, Tojo R, Rodriguez M, Lucena Ma I, Andrade R J
Gastroenterology Service, Hospital Central de Asturias, Oviedo, Spain.
Scand J Gastroenterol. 2002 Nov;37(11):1341-3. doi: 10.1080/003655202761020650.
We present the case of a 63-year-old woman who had undergone 7 months of treatment with Nimesulide (100 mg/b.i.d.) for symptomatic osteoarthritis. The patient was admitted to our unit with a clinical picture of progressive jaundice over 3 weeks. Clinical and analytical studies revealed acute liver failure, this being confirmed by liver biopsy, which showed submassive necrosis. Serological tests for different viral agents causing hepatitis were all negative. In addition, she presented a picture of severe haemolytic anaemia resistant to several treatments and needed multiple transfusions. Twenty-three days after admission, the patient presented hepatic encephalopathy and received an orthotopic liver transplant on day 25. The evolution after transplantation was good and the patient continues in good health with no evidence of haemolysis almost 2 years later. Liver toxicity due to Nimesulide is well known, but to our knowledge the occurrence of haemolytic anaemia has not been related to this drug previously. For these reasons, Nimesulide has been restricted or removed from the market in several countries in recent months.
我们报告了一例63岁女性病例，该患者因症状性骨关节炎接受了7个月的尼美舒利（100毫克/每日两次）治疗。患者因持续3周的进行性黄疸临床表现入住我院。临床和分析研究显示为急性肝衰竭，肝活检证实了这一点，活检显示为亚大块坏死。针对不同引起肝炎的病毒病原体的血清学检测均为阴性。此外，她还出现了对多种治疗耐药的严重溶血性贫血，需要多次输血。入院23天后，患者出现肝性脑病，并于第25天接受了原位肝移植。移植后的病情进展良好，近2年后患者仍健康状况良好，无溶血迹象。尼美舒利导致的肝毒性是众所周知的，但据我们所知，溶血性贫血的发生此前尚未与该药物相关联。基于这些原因，近几个月来，尼美舒利在几个国家已被限制使用或退出市场。
