Department of Medicine A, Hematology and Oncology, University Hospital of Münster; Albert-Schweitzer-Campus 1, D-48149 Münster, Germany.
Department of Medicine II, Hematology and Oncology, University Hospital of Augsburg; Stenglinstr. 2, D-86156 Augsburg, Germany.
Curr Drug Saf. 2023;18(3):404-412. doi: 10.2174/1574886317666220606150721.
Metamizole is one of the most used analgesic, antipyretic, and spasmolytic agents in many countries worldwide. While metamizole-induced agranulocytosis is an, albeit seldom, well-known adverse event, metamizole-associated drug-induced liver injury has been reported rarely in the literature and hence often remains unconsidered. Here, we present a unique case where metamizole-induced hepatotoxicity got unmasked by the simultaneous development of characteristic agranulocytosis.
A 22-year-old woman without known conditions presented with a new onset of fever, jaundice, and maculopapular rash and explicitly denied intake of any new substances. Laboratory tests showed liver injury, granulopenia, and positive anti-nuclear and anti-mitochondrial (AMA-M2) antibodies. Liver biopsy revealed a histological pattern characteristic of drug-induced liver injury and bone marrow biopsy, the classical picture of metamizole-induced agranulocytosis. Indeed the in-depth interview of the patient unveiled metamizole consumption over the last two months. Therefore, we could diagnose metamizole-induced hepato- and myelotoxicity. Accordingly, steroid therapy led to normalization of liver parameters and stimulation with granulocyte colony- stimulating factor to leukocyte recovery.
This case report is intended to increase the awareness of metamizole-associated druginduced liver injury which should always be kept in mind due to its occasionally life-threatening course. Diagnosis can be difficult particularly if anamnesis and written records are without hints for prior metamizole intake.
甲灭酸是世界上许多国家最常用的镇痛、解热和痉挛缓解药物之一。虽然甲灭酸引起的粒细胞缺乏症是一种众所周知的不良反应，但文献中很少报道甲灭酸相关的药物性肝损伤，因此常常被忽视。在这里，我们报告了一个独特的病例，甲灭酸诱导的肝毒性通过同时发生特征性的粒细胞缺乏症而显现出来。
一名 22 岁的女性，无已知疾病，出现发热、黄疸和斑丘疹，并明确否认摄入任何新物质。实验室检查显示肝损伤、粒细胞减少和抗核抗体和抗线粒体抗体（AMA-M2）阳性。肝脏活检显示药物性肝损伤的组织学模式和骨髓活检显示甲灭酸诱导的粒细胞缺乏症的典型表现。实际上，对患者的深入访谈揭示了过去两个月来一直在服用甲灭酸。因此，我们可以诊断为甲灭酸引起的肝和骨髓毒性。相应地，皮质类固醇治疗导致肝参数正常化，粒细胞集落刺激因子刺激白细胞恢复。
本病例报告旨在提高对甲灭酸相关药物性肝损伤的认识，由于其偶尔具有威胁生命的病程，应始终牢记这一点。诊断可能很困难，特别是如果病史和书面记录没有提示之前有甲灭酸摄入。
