常用量アセトアミノフェンによる昏睡型急性肝不全の一例

Le résumé fourni par la source

Acetaminophen (AAP) is an antipyretic and analgesic drug with fewer side effects than NSAIDs, and is frequently prescribed for the elderly and patients with hepatic and renal dysfunction. On the other hand, known side effects of AAP include hepatic damage, for which reason its dose is recommended to be less than 1,500 mg/day in patients with hepatic disease. Herein, we describe a case of acute hepatic failure with hepatic coma attributed to regular doses of AAP. A 73-year-old woman in a coma was brought to our hospital. She had been taking 1,200 mg/day of AAP for 2 months after a total knee arthroplasty for left knee osteoarthritis. At the time of admission, the patient’s Japan Coma Scale (JCS) score was 200; she had jaundice and generalized edema. With severe liver dysfunction, coagulopathy, and hepatic atrophy, she was diagnosed with acute hepatic failure and hepatic coma. Despite aggressive multidisciplinary treatment, the patient died on the seventh day of hospitalization, with convulsions and worsening of respiratory status. We concluded that this was a case of drug-induced liver injury (DILI) caused by AAP. The risk of DILI was considered to be high due to the presence of nonalcoholic fatty liver disease (NAFLD), previously diagnosed, and advanced age. In patients at risk of DILI, as in the present case, periodic liver function tests should guide the cessation or dose reduction of AAP to minimize risks of hepatic dysfunction and possible mortality.

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