Korean J Med.  2000 Jul;59(1):114-119.

A case of nimesulide induced hepatitis

• Chae HB
• Choi WJ
• Lee MW
• Park SM
• Kim HY
• Cho MC
• Sung RH
• Youn SJ

Abstract

Nimesulide, highly selective cyclooxygenase inhibitor-2, is a newly developed, non-steroidal anti-inflammatory drug (NSAID) with low toxicity in gastrointestinal tract. But recently, seven cases of nimesulide-induced hepatitis of which types were hepatocellular, hepatocanalicular, and mixed damage were reported. Our case of nimesulide-induced hepatic damage was mixed cholestatic and hepatotoxic hypersensititvity reaction, and her story was as follows. A 70-year female patient's first hepatic event happened in Jaunuary, 1998 after taking nimesulide 200mg daily for 50 days from November 1997, but it was cleared. She was admitted to our unit because of jaundice, edema and ascites in May, 1998 after retrial of nimesulide 150 mg daily for 50 days. Biochemical determinations showed increase of AST (181 IU/L), ALT (110 IU/L), bilirubin (20.3 mg/dL) and albumin (2.3 g/dL). Prothrombin time was also prolonged upto 2.51 INR. But neither viral markers such as anti-HCV, HBsAg, anti-HBc IgM, anti-HAV IgM, anti-CMV, anti-EBV IgG and IgM nor other immunologic markers such as ANA, SMA, and AMA were positive. Ultrasonography showed diffuse hyperechogenicity in liver and mild splenomegaly but no dilatation in biliary tract. Liver biopsy showed portal to portal bridging necrosis with severe hepatocytic cholestasis. Her liver function returned to normal after discontinuation of nimesulide. At 8 months after beginning treatment, she complained of recurrent epistaxis and abdominal distension. At this time, her liver biopsy showed cirrhosis. In conclusion, we considered that this case was nimesulide-induced Liver cirrhosis.

Keyword

Abdominal abscess; Catheterization; Drainage

MeSH Terms

Abdominal Abscess
Ascites
Biliary Tract
Bilirubin
Biomarkers
Biopsy
Catheterization
Cholestasis
Dilatation
Drainage
Edema
Epistaxis
Female
Fibrosis
Gastrointestinal Tract
Hepatitis A Antibodies
Hepatitis B Surface Antigens
Hepatitis*
Humans
Immunoglobulin G
Immunoglobulin M
International Normalized Ratio
Jaundice
Liver
Liver Cirrhosis
Necrosis
Prostaglandin-Endoperoxide Synthases
Prothrombin Time
Splenomegaly
Ultrasonography
Bilirubin
Hepatitis A Antibodies
Hepatitis B Surface Antigens
Immunoglobulin G
Immunoglobulin M
Prostaglandin-Endoperoxide Synthases