RESULTS: Among the 93 reviewed patients, 3 presented severe and icteric toxic hepatitis which was fatal for 1 patient. [ncbi.nlm.nih.gov]

They presented three cases in adults. Shortly thereafter Kohn 2 and Willis 3 each presented a case in an infant. Wood 4 studied 522 patients, 144 children and 378 adults, receiving sulfanilamide and found that 21 developed acute anemia. [annals.org]

• Fever

  More common in children Cholestatic type Idiosyncratic reaction Nausea, vomiting, fever, RUQ pain, jaundice, leukocytosis, elevated aminotransferases Clinical improvement upon drug withdrawal No evidence of CLD on follow up 19. [slideshare.net]

  If fever, rash, or pruritis occurs from any medication, its use should be stopped immediately. [hepatitiscentral.com]

  Fever and marked elevation of liver enzymes occurred after the fifteenth PUVA treatment and spontaneously returned to normal within 5 days. [ncbi.nlm.nih.gov]

• Malaise

  Chronic hepatitis can cause loss of appetite, tiredness, low-grade fever, and a general sense of "not feeling well" that doctors call malaise (ma-LAZE). Again, there are often no symptoms. [humanillnesses.com]

  These incidents usually occur during the first 6 months of treatment and are preceded by nonspecific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, vomiting, and even loss of seizure control. [emedicine.medscape.com]

• Painless Jaundice

  Johnson, 62-Year-Old Man With Painless Jaundice and Hyponatremia, Mayo Clinic Proceedings, 10.1016/j.mayocp.2012.09.009, 88, 6, (e49-e53), (2013). [doi.org]

• Nausea

  More common in children Cholestatic type Idiosyncratic reaction Nausea, vomiting, fever, RUQ pain, jaundice, leukocytosis, elevated aminotransferases Clinical improvement upon drug withdrawal No evidence of CLD on follow up 19. [slideshare.net]

  An overdose of certain medications like paracetamol can lead to liver failure, which is why medical assistance in case of signs such as abdominal pain, exploitation, nausea and vomiting, and coma is necessary. [health-factbook.com]

  After discharge from the hospital, the patient developed severe nausea and vomiting. She was readmitted to the hospital the day after surgery because of persistent nausea, vomiting, retching, and dehydration. [anesthesiology.pubs.asahq.org]

  The disease is accompanied by pain in the right hypochondrium, nausea, indigestion, fever. [en.intoxication-stop.com]

  Anorexia, nausea, and vomiting are the usual symptoms; jaundice and hepatomegaly are noted on physical assessment. Symptoms are more intense for the more severely toxic patient. [hepatitiscentral.com]

• Vomiting

  More common in children Cholestatic type Idiosyncratic reaction Nausea, vomiting, fever, RUQ pain, jaundice, leukocytosis, elevated aminotransferases Clinical improvement upon drug withdrawal No evidence of CLD on follow up 19. [slideshare.net]

  The patient was presented with symptoms and findings of anorexia, vomiting and jaundice. For diagnosis, other acute hepatitis etiologies were excluded. [ncbi.nlm.nih.gov]

  An overdose of certain medications like paracetamol can lead to liver failure, which is why medical assistance in case of signs such as abdominal pain, exploitation, nausea and vomiting, and coma is necessary. [health-factbook.com]

  After discharge from the hospital, the patient developed severe nausea and vomiting. She was readmitted to the hospital the day after surgery because of persistent nausea, vomiting, retching, and dehydration. [anesthesiology.pubs.asahq.org]

  Anorexia, nausea, and vomiting are the usual symptoms; jaundice and hepatomegaly are noted on physical assessment. Symptoms are more intense for the more severely toxic patient. [hepatitiscentral.com]

• Loss of Appetite

  Others may have Loss of appetite Nausea and vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Jaundice, yellowing of skin and eyes Some forms of hepatitis are mild, and others can be serious. [icdlist.com]

  Weight loss. Rash. Loss of appetite. Nausea and vomiting. Dark colored urine. What Causes Toxic Hepatitis ? The condition is known to occur when the liver becomes inflamed. The inflammation occurs due to the exposure to some toxic substance. [natural-health-news.com]

  Symptoms Symptoms of toxic hepatitis include: Yellowing of the eyes and skin— jaundice Nausea Vomiting Dark or brown-colored stools White or light-colored stools Loss of appetite Pain in the upper right portion of the abdomen Dark or tea-colored urine [winchesterhospital.org]

  Usually, mild hepatitis does not produce any symptoms, but when present they include: Jaundice (yellowing of skin and eyes) Either brown or white-colored stools Dark or tea-colored urine Nausea and vomiting Loss of appetite Pain in the upper right quadrant [gleneaglesglobalhospitals.com]

  However, if the symptoms occur, they may include: yellowing of the skin and whites of the eyes (jaundice) itching, abdominal pain in the upper right part, excessive fatigue and weakness, loss of appetite, nausea and vomiting, rash, weight loss, dark urine [health-factbook.com]

• Jaundice

  Liver function tests suggested cholestatic jaundice. The mortality rate in the hospital was 10%. Clinical features in dogs were similar, but mortality was almost 100%. [ncbi.nlm.nih.gov]

  Combination of estrogenic and progestational steroids; estrogen is primarily responsible Intrahepatic cholestasis Pruritus and jaundice Susceptible patients: idiopathic jaundice of pregnancy, family history Focal nodular hyperplasia, adenomas 20. [slideshare.net]

  In addition to the elevation of ALT and AST levels, cases of liver necrosis, jaundice, and fulminant hepatitis with and without jaundice have occurred. [emedicine.medscape.com]

  This compound produces cholestasis and hepatic necrosis in many animals and caused the so-called Epping jaundice when 84 persons ate bread contaminated with it. [nejm.org]

• Hepatomegaly

  It is concluded that the hepatomegaly noted in patients given short-term, high-dosage steroid therapy is due to excessive glycogen accumulation within parenchymal cells. [doi.org]

  Hepatomegaly was recorded when ascites decreased. Liver function tests suggested cholestatic jaundice. The mortality rate in the hospital was 10%. Clinical features in dogs were similar, but mortality was almost 100%. [ncbi.nlm.nih.gov]

  Findings include: hepatomegaly >15.5 cm at the midclavicular line 4 possible decreased attenuation around the portal system and at the hepatic hilum (periportal edema) possible diffusely decreased parenchymal attenuation on noncontrast CT diffuse edematous [radiopaedia.org]

  ALP isoenzyme test (Medical Encyclopedia) Ascites (Medical Encyclopedia) Diet - liver disease (Medical Encyclopedia) Hepatic encephalopathy (Medical Encyclopedia) Hepatomegaly (Medical Encyclopedia) Liver disease (Medical Encyclopedia) Liver scan (Medical [icdlist.com]

  Anorexia, nausea, and vomiting are the usual symptoms; jaundice and hepatomegaly are noted on physical assessment. Symptoms are more intense for the more severely toxic patient. [hepatitiscentral.com]

• Scleral Icterus

  A 47-year-old woman was admitted to our clinic with weakness, fatigue, pruritus, and scleral icterus that had developed 10 days prior to presentation. [ncbi.nlm.nih.gov]

  Patient 1 On July 16, 1992, a 42-year-old man visited his family physician for evaluation of scleral icterus and diffuse jaundice. [cdc.gov]

• Dark Urine

  Four weeks later; he developed dark urine and pale stools, associated with asthenia and right hypochondrial pain. Two months after starting treatment, he was referred to the hepatology department with jaundice. [ncbi.nlm.nih.gov]

  Later, there may be jaundice and dark urine and an enlarged and tender liver. When the offending medication is withdrawn, symptoms may gradually subside. Reactions may be severe, however, and even fatal, even though the medication is stopped. [hepatitiscentral.com]

  However, if the symptoms occur, they may include: yellowing of the skin and whites of the eyes (jaundice) itching, abdominal pain in the upper right part, excessive fatigue and weakness, loss of appetite, nausea and vomiting, rash, weight loss, dark urine [health-factbook.com]

  urine Light stool If you notice any of the aforementioned symptoms, repeating for a certain period of time, visit your doctor immediately. [healthawarenesscommunity.com]

  Some of the common symptoms are: nausea vomiting headache anorexia jaundice clay color stools dark urine hepatomegaly Diagnosis Diagnosis is typically made through a physical exam along with a patient history to identify any possible hepatotoxins. [medical-dictionary.thefreedictionary.com]

The diagnostic workup showed no other cause and liver histology was consistent with substance-induced toxic hepatitis. Within two weeks of conservative therapy, his liver function tests returned to normal. [ncbi.nlm.nih.gov]

[…] cardiovascular causes, especially right-sided heart failure Cholecystitis Cholangitis Budd-Chiari syndrome Alcoholic liver disease Cholestatic liver disease Pregnancy-related conditions of liver Malignancy Wilson disease Hemochromatosis Coagulation disorders Workup [emedicine.medscape.com]

Abstract Flutamide is a nonsteroidal antiandrogen commonly used in the treatment of prostate cancer. Hepatic toxicity associated with flutamide has been reported with an incidence from less than 1% to about 5%. [ncbi.nlm.nih.gov]

Awareness of this complication should prompt earlier investigation because early diagnosis coupled with timely therapeutic measures may improve patient prognosis. [ncbi.nlm.nih.gov]

JCO. 2002, 20:2789-2797 Mavros MN, Mayo SC, Hyder O, Pawlik TM A systematic review treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma. [ivyunion.org]

Treatment and prognosis Treatment depends on the etiology of the acute hepatitis. [radiopaedia.org]

Prognosis Usually the symptoms will go away after the drug has been eliminated due to the liver repairing itself. A full recovery is typically expected unless it wasn't treated quickly resulting in more liver damage being done than normal. [medical-dictionary.thefreedictionary.com]

Forecast In general, with timely diagnosis and proper treatment, the prognosis is favorable. The liver has an exceptional ability to regenerate and easily restores up to 75% of dead cells. [en.intoxication-stop.com]

For diagnosis, other acute hepatitis etiologies were excluded. Roussel Uclaf Causality Assessment Method (RUCAM) score was calculated and found to be 10, which meant highly probable drug hepatotoxicity. [ncbi.nlm.nih.gov]

ICD-10-CM Codes › K00-K95 Diseases of the digestive system › K70-K77 Diseases of liver › Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Etiologies may include: viral hepatitides: (e.g. [radiopaedia.org]

A retrospective epidemiological survey was carried out. The disease had a subacute onset starting with high fever, followed by rapidly progressive jaundice. Ascites appeared simultaneously and soon became quite massive. [ncbi.nlm.nih.gov]

About 10% of cases are idiosyncratic. [ 1 ] Epidemiology A very large number of drugs have been implicated as a potential cause of drug-induced hepatitis but with variable risk of both frequency and severity. [patient.info]

Odin, Epidemiology and Genetic Risk Factors of Drug Hepatotoxicity, Clinics in Liver Disease, 21, 1, (55), (2017). L. Dara, Z.-X. Liu and N. [doi.org]

In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Aug. 17, 2016. Couturier FJ, et al. [mayoclinic.org]

Definition / general Drug / toxin reactions can be intrinsic or predictable, where they are dose dependent (e.g. acetaminophen ); or idiosyncratic and unpredictable, where they are dose independent (e.g. isoniazid) Pathophysiology Underlying mechanisms [pathologyoutlines.com]

[…] and mechanisms of drug-induced liver injury Pathophysiologic mechanisms The pathophysiologic mechanisms of hepatotoxicity are still being explored and include both hepatocellular and extracellular mechanisms. [emedicine.medscape.com]

Pathophysiology and natural history of drug-induced cholangiopathies remain unclear. [doai.io]

Cholinesterase inhibitors prevent the hydrolysis of acetylcholine and are currently approved for the symptomatic treatment of Alzheimer's disease. [ncbi.nlm.nih.gov]

Increased awareness will help achieve the correct diagnosis, prevent unnecessary procedures such as liver biopsy, minimize expensive evaluations, and prevent patients from developing fatal liver failure. [dx.doi.org]

Prevention Exposure to toxic substances in the workplace can be prevented with proper use of protective clothing and gear. People who are at risk due to liver disease should check with their doctor for a list of medications to avoid. [winchesterhospital.org]