Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Augustenburger Platz 1, 13353, Berlin, Germany.
Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Transplant Proc. 2022 Sep;54(7):1854-1858. doi: 10.1016/j.transproceed.2022.04.028. Epub 2022 Aug 4.
Metamizole, or dipyrone, is a frequently prescribed analgetic drug that can cause drug-induced liver injury (DILI). Still, there are only a few metamizole-associated DILI cases (n = 61, including our study) described in the literature. So far liver transplantation has been reported in 6 patients with metamizole-induced acute liver failure. In 2020, a German group described a bigger cohort (n = 23) of metamizole-related DILI. Shortly thereafter, this issue gained wider attention as the German Federal Institute for Drugs and Medical Devices published a Direct Healthcare Professional Communication, emphasizing DILI as a potential adverse event caused by metamizole. We herein report 2 patients that were admitted to our liver transplant center due to acute liver failure (ALF) in April and May 2021. Both patients reported intake of metamizole as pain medication over a few weeks. After ruling out alternative reasons for ALF and fulfilling the King's College criteria both patients received emergency liver transplantations in our center. Pathology assessment of both explants were consistent with metamizole-associated DILI. As illustrated by our 2 cases of metamizole-induced liver failure with subsequent liver transplantation, this rare but presumably often overlooked adverse drug effect of metamizole should be considered as differential diagnosis in cases of cryptogenic liver failure.
扑热息痛，又称二甲苯氧胺，是一种常用的止痛药物，但可能导致药物性肝损伤（DILI）。然而，文献中仅描述了少数几例扑热息痛相关的 DILI 病例（n=61，包括我们的研究）。迄今为止，已有 6 例扑热息痛诱导的急性肝衰竭患者接受了肝移植。2020 年，一个德国研究小组描述了一个更大的扑热息痛相关 DILI 队列（n=23）。此后不久，这一问题引起了更广泛的关注，因为德国联邦药品和医疗器械研究所发布了一份直接面向医疗保健专业人员的通讯，强调扑热息痛可能导致 DILI 这一潜在的不良事件。在此，我们报告了 2021 年 4 月和 5 月因急性肝衰竭（ALF）入住我们肝移植中心的 2 例患者。这 2 名患者均报告在数周内服用扑热息痛作为止痛药物。排除了 ALF 的其他原因，并符合 King 学院标准后，这 2 名患者均在我们中心接受了紧急肝移植。对这 2 例肝移植标本的病理学评估均与扑热息痛相关的 DILI 一致。正如我们报告的 2 例扑热息痛引起的肝衰竭随后进行肝移植的病例所示，扑热息痛这种罕见但据推测通常被忽视的药物不良反应，在不明原因的肝衰竭病例中应作为鉴别诊断的考虑因素。
