Soares Ana Raquel, Fiúza Pedro, Rodrigues João, Guisado Orantos Marta, Nascimento Paula
Internal Medicine, Unidade Local de Saúde de São José, Lisbon, PRT.
Pulmonology, Unidade Local de Saúde de São José, Lisbon, PRT.
Cureus. 2024 Dec 2;16(12):e74955. doi: 10.7759/cureus.74955. eCollection 2024 Dec.
Acute liver failure (ALF) is a rare, life-threatening condition that may be secondary to drug-induced liver injury (DILI) and certain viral infections. We present the case of a 73-year-old male with a history of fibrotic hypersensitivity pneumonitis with a progressive phenotype, type 2 diabetes mellitus, hypertension, and hyperlipidemia, who was admitted with ALF potentially secondary to DILI. Prior to admission, he was receiving therapy that may be related to idiosyncratic DILI (I-DILI) and ALF, namely nintedanib, which appears to have a most probable relation to I-DILI in this case, considering it was the most recently started drug. Herpes simplex virus (HSV) type 1 was also identified and probably potentiated I-DILI development and ALF. Considering the patient's history and previous medical status, he was not considered eligible for liver transplantation in the setting of a multidisciplinary discussion. Despite therapy with N-acetylcysteine and acyclovir, there was progressive clinical deterioration with worsening of encephalopathy, and the patient died. This case represents a rare and complex situation of ALF following I-DILI potentiated by HSV type 1 infection, reflecting its high mortality risk in patients not undergoing liver transplantation.
急性肝衰竭（ALF）是一种罕见的、危及生命的疾病，可能继发于药物性肝损伤（DILI）和某些病毒感染。我们报告一例73岁男性病例，该患者有进行性表型的纤维化性过敏性肺炎病史、2型糖尿病、高血压和高脂血症，因可能继发于DILI的ALF入院。入院前，他正在接受可能与特异质性DILI（I-DILI）和ALF相关的治疗，即尼达尼布，考虑到它是最近开始使用的药物，在本病例中它似乎与I-DILI关系最为密切。还检测出1型单纯疱疹病毒（HSV），它可能促进了I-DILI的发展和ALF。考虑到患者的病史和既往医疗状况，在多学科讨论中认为他不符合肝移植条件。尽管使用了N-乙酰半胱氨酸和阿昔洛韦进行治疗，但患者的临床状况仍不断恶化，脑病加重，最终死亡。该病例代表了1型HSV感染增强的I-DILI后发生ALF的一种罕见且复杂的情况，反映出未接受肝移植的患者其死亡风险很高。
