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Toxic Hepatitis


Presentation

  • RESULTS: Among the 93 reviewed patients, 3 presented severe and icteric toxic hepatitis which was fatal for 1 patient.[ncbi.nlm.nih.gov]
  • Case Report : Herein, we present the case of 47 year old woman with recurrent acute toxic hepatitis after a single intake of albendazole in 2010 and 2014. The patient was presented with symptoms and findings of anorexia, vomiting and jaundice.[ncbi.nlm.nih.gov]
  • We present a 26-year-old male bodybuilder who self-administered high doses of androgenic/anabolic steroids that induced liver damage.[ncbi.nlm.nih.gov]
  • A case of toxic hepatitis caused by combination therapy with methotrexate and etretinate in the treatment of severe psoriasis is presented in a 47-year-old woman.[ncbi.nlm.nih.gov]
  • Here we report an additional case of toxic hepatitis associated with dronedarone presenting with acute liver failure, followed by spontaneous recovery, in a 69-year old woman.[ncbi.nlm.nih.gov]
Fever
  • 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]
  • Abstract An epidemic of liver disease, characterized by onset with high fever, rapidly progressive jaundice, and ascites occurred in a rural area of India. Several hundred people were affected and mortality was high.[ncbi.nlm.nih.gov]
  • If fever, rash, or pruritis occurs from any medication, its use should be stopped immediately.[hepatitiscentral.com]
  • The disease had a subacute onset starting with high fever, followed by rapidly progressive jaundice. Ascites appeared simultaneously and soon became quite massive. Hepatomegaly was recorded when ascites decreased.[ncbi.nlm.nih.gov]
  • 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]
Malaise
  • […] erythema, urticaria, pruritus, alopecia, xeroderma Musculoskeletal and Connective Tissue Disorders: myalgia Reproductive System and Breast Disorders: menstrual disorder General Disorders and Administration Site Conditions: asthenia, fatigue, hot flush, malaise[drugs.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
  • 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]
  • The disease is accompanied by pain in the right hypochondrium, nausea, indigestion, fever.[en.intoxication-stop.com]
  • IV fluid is recommended for people who experience extreme nausea and vomiting. Symptoms usually go away within a few days or weeks.[winchesterhospital.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]
  • 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]
Vomiting
  • 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]
  • IV fluid is recommended for people who experience extreme nausea and vomiting. Symptoms usually go away within a few days or weeks.[winchesterhospital.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]
  • 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]
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]
  • 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]
  • But, when the symptoms appear, they can be as follows: Jaundice (yellowing of the whites of the eyes and skin) Irritated skin and itching Pain in the upper part of the abdomen Exhaustion and fatigue Vomiting Nausea Loss of appetite Skin rash Increased[healthawarenesscommunity.com]
  • 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]
Acute Abdomen
  • Our aim was to determine the cause of strikingly elevated liver enzymes in a case with systemic lupus presenting with acute abdomen.[ncbi.nlm.nih.gov]
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]
  • We report a 60-year-old man with exfoliative dermatitis, jaundice, increase in liver enzymes and eosinophilia one day after accidental dermal exposure to butachlor toxin.[ncbi.nlm.nih.gov]
  • The case of a patient who presented severe hepatitis with jaundice following use of flutamide is reported. UDCA treatment was started on admission and, contemporaneously, flutamide was withdrawn.[ncbi.nlm.nih.gov]
  • Abstract An epidemic of liver disease, characterized by onset with high fever, rapidly progressive jaundice, and ascites occurred in a rural area of India. Several hundred people were affected and mortality was high.[ncbi.nlm.nih.gov]
  • 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]
Hepatomegaly
  • 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]
  • 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]
  • 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]
  • She was admitted to the hospital for evaluation; physical examination revealed marked jaundice but no hepatomegaly. Findings of an abdominal sonogram and barium enema were normal. Laboratory test results for hepatitis A and B were negative.[cdc.gov]
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]
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]
Distractibility
  • In the process of examination, a specialist should not be distracted from damage to the kidneys and other organs. Along with changes in the liver, damage to other organs may ultimately be fatal.[acikgunluk.net]
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]
  • urine Light stool If you notice any of the aforementioned symptoms, repeating for a certain period of time, visit your doctor immediately.[healthawarenesscommunity.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; sometimes nerve disorders as a result of exposure to toxins on the nervous system.[en.intoxication-stop.com]

Workup

  • 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]
Neurofibrillary Tangle
  • It is characterized by the presence of senile plaques and neurofibrillary tangles in the brain, and impairment of the central cholinergic system, which contribute to memory loss and cognitive dysfunction.[ncbi.nlm.nih.gov]

Treatment

  • 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]
  • We present a case of toxic hepatitis related to infliximab treatment in a 38-year-old woman with rheumatoid arthritis (RA).[ncbi.nlm.nih.gov]
  • She had been taking topiramate for one year for treatment of chronic isolated central nervous system vasculitis.[ncbi.nlm.nih.gov]
  • Cholinesterase inhibitors prevent the hydrolysis of acetylcholine and are currently approved for the symptomatic treatment of Alzheimer's disease.[ncbi.nlm.nih.gov]
  • In the industrial waste treatment process, the danger of developing toxic hepatitis should be kept in mind, because any subtle change of the treatment process can generate various toxic materials and threaten the workers' health.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • 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]
  • 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]

Etiology

  • The etiology of the disease could not be unequivocally established, but aflatoxins, perhaps in combination with other factors, may have been the cause.[ncbi.nlm.nih.gov]
  • 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]
  • Etiology of this epidemic of hepatitis could not be unequivocally established. Critical analysis of the data suggests that some food toxin may have been a factor in the outbreak of this unusual epidemic of toxic hepatitis.[ncbi.nlm.nih.gov]
  • This volume reviews today’s knowledge about hepatitis with emphasis on comparative aspects between hepatitis in humans and animals, but also between different etiological agents.[books.google.com]
  • 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]

Epidemiology

  • 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]
  • Woven throughout the content is new and updated material that reflects key practice differences in Canada, ranging from the healthcare system, to cultural considerations, epidemiology, pharmacology, Web resources, and more.[books.google.com]
  • Chan, Primary Carcinomas of the Liver in Hong Kong: Some Possible Aetiological Factors, Current Problems in the Epidemiology of Cancer and Lymphomas, 10.1007/978-3-662-41032-5_10, (107-118), (1972). Marjorie V.[doi.org]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed Aug. 17, 2016. Couturier FJ, et al.[mayoclinic.org]
  • Bile Acid-Induced Hepatocyte Apoptosis Bile formation is an essential function of the liver, and failure of bile formation is a pathophysiologic process termed cholestasis.[doi.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]

Prevention

  • Cholinesterase inhibitors prevent the hydrolysis of acetylcholine and are currently approved for the symptomatic treatment of Alzheimer's disease.[ncbi.nlm.nih.gov]
  • The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea.[ncbi.nlm.nih.gov]
  • 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]
  • Supportive conservative care includes a proper diet and measures to avoid and treat dehydration, bed rest, and prevention of malnourishment.[gleneaglesglobalhospitals.com]
  • Gas6-deficiency, by limiting cytokine/chemokine release, prevents hepatocyte proliferation, recruitment of circulating monocytes and accumulation of myofibroblasts in healing areas.[ncbi.nlm.nih.gov]

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