Induced by medication hepatotoxicity in an ambulatorial patient: case report

Abstract

Background: Drug-induced hepatitis, also called toxic hepatitis or DILI (Drug Induced Liver Injury), accounts for about 2% of hospitalization cases of jaundice and liver damage is involved in 3-10% of all adverse drug reactions. Cases of hepatic injury associated with ibuprofen use are rare and the frequency of idiosyncratic hepatotoxicity is small. Objective: To report a case of hepatic injury induced by ibuprofen identified in a medium complexity outpatient clinic. Case report: A 48-year-old female patient was admitted to a Specialized Care Center in the southwestern state of Bahia for a consultation with an orthopedist complaining of low back pain, and ibuprofen and sodium dipyrone were prescribed to relieve symptoms. After 15 days of treatment, the patient returns to the service complaining of arthralgia in the upper limbs, right hand edema, jaundice, coluria, fecal suppura, asthenia and intense pruritus. From the investigation of the presented case, viral and autoimmune etiologies were ruled out. Ultrasonography of the total abdomen showed a slight abnormal texture of the liver and gallstones in motion, being suggestive of choledocholithiasis. After evaluation of causality and application of RUCAM, the reaction was classified as highly probable. Conclusions: The hepatic injury shown by the patient has a strong causal relationship with the use of ibuprofen.