Al Mutairi Fawaz, Dwivedi Girish, Al Ameel Turki
Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
J Med Case Rep. 2012 Dec 12;6:418. doi: 10.1186/1752-1947-6-418.
Fulminant hepatic failure is a serious disease with significant mortality and morbidity. Identifying the exact cause of hepatic failure and predicting prognosis is of paramount importance in managing such patients. Drug-induced liver injury is a common but challenging entity to treat. The use of newer drugs and medications with previously unknown hepatotoxicity add to the challenges faced by treating physicians. Quetiapine is an antipsychotic that has rarely been linked to acute liver injury. In the present work we describe a case of fulminant hepatic failure secondary to use of quetiapine.
A 59-year-old Caucasian woman with known Parkinson's disease was being treated with quetiapine for hallucinations. She was referred to our hospital with yellow discoloration of the sclera and later on developed clinical features suggestive of hepatic encephalopathy. A diagnosis of fulminant hepatic failure was made following her admission to the intensive care unit. Her condition improved after discontinuing the drug and providing the standard supportive treatment.
Our findings in the present report emphasize the importance of keeping an open mind in cases of fulminant hepatic failure. As drug-induced hepatotoxicity is the most common cause of fulminant hepatic failure in many parts of the world, consideration should be given to the medication(s) patients receive as the potential cause and a review of this list should be part of the clinical care given.
暴发性肝衰竭是一种严重疾病，死亡率和发病率都很高。确定肝衰竭的确切病因并预测预后对于此类患者的管理至关重要。药物性肝损伤是一种常见但治疗具有挑战性的病症。使用新药物以及具有先前未知肝毒性的药物增加了治疗医生面临的挑战。喹硫平是一种抗精神病药物，很少与急性肝损伤相关联。在本研究中，我们描述了一例因使用喹硫平继发暴发性肝衰竭的病例。
一名59岁患有帕金森病的白人女性因幻觉正在接受喹硫平治疗。她因巩膜黄染被转诊至我院，随后出现提示肝性脑病的临床特征。入住重症监护病房后被诊断为暴发性肝衰竭。停用药物并给予标准支持治疗后，她的病情有所改善。
我们在本报告中的发现强调了在暴发性肝衰竭病例中保持开放思维的重要性。由于药物性肝毒性是世界许多地区暴发性肝衰竭最常见的病因，应考虑患者所接受的药物作为潜在病因，对该清单进行审查应成为临床护理的一部分。
