Anandabaskaran Sulakchanan, Ho Vincent
Department of Medicine, Campbelltown Public Hospital, Campbelltown, NSW, 2560, Australia.
Department of Gastroenterology, Campbelltown Public Hospital, Campbelltown, NSW, 2560, Australia.
J Med Case Rep. 2018 Feb 24;12(1):46. doi: 10.1186/s13256-018-1563-9.
Bupropion is an antidepressant that is also used as a non-nicotine method to aid in smoking cessation. Bupropion-induced hepatotoxicity is quoted to affect between 0.1% and 1% of treated patients with either a hepatocellular and/or cholestatic pattern of damage. The mechanism of damage is considered to be predominantly immune-mediated with the presence of a hypersensitivity syndrome (fever, rash, eosinophilia, autoantibodies) and a short latency period (1-6 weeks). We believe our reporting of this case to the already existing small list of only seven cases in the world literature will help practicing physicians to deal with the diagnostic and management dilemmas that bupropion-induced hepatotoxicity brings.
A 50-year-old Caucasian woman presented to our hospital with significant derangement of liver transaminases after 6 days of bupropion treatment for smoking cessation. The patient's other medications were considered unlikely to be the cause of the hepatotoxicity and were therefore continued. The patient's liver function tests normalized on withdrawal of bupropion, confirming that bupropion was the probable cause of the patient's hepatotoxicity.
We conclude that hepatotoxicity is a rare adverse effect of bupropion use, but physicians should be aware of the possibility of this potentially serious clinical picture of drug-induced hepatotoxicity with varied clinical presentation and prognosis.
安非他酮是一种抗抑郁药，也被用作一种非尼古丁方法来辅助戒烟。据报道，安非他酮引起的肝毒性会影响0.1%至1%接受治疗的患者，损伤模式为肝细胞性和/或胆汁淤积性。损伤机制被认为主要是免疫介导的，伴有超敏反应综合征（发热、皮疹、嗜酸性粒细胞增多、自身抗体）且潜伏期较短（1 - 6周）。我们认为，将此病例报告到世界文献中仅有的七例小名单中，将有助于执业医师应对安非他酮引起的肝毒性所带来的诊断和管理难题。
一名50岁的白人女性在接受安非他酮治疗戒烟6天后，因肝转氨酶显著异常前来我院就诊。患者的其他药物被认为不太可能是肝毒性的原因，因此继续使用。停用安非他酮后患者的肝功能检查恢复正常，证实安非他酮可能是患者肝毒性的原因。
我们得出结论，肝毒性是使用安非他酮罕见的不良反应，但医生应意识到这种药物性肝毒性潜在严重临床表现的可能性，其临床表现和预后各不相同。
