propylthiouracil and Liver-Failure--Acute

This study investigated the prognostic parameters and beneficial effects of repeat plasma exchange in children with acute liver failure (ALF).. Twenty-three patients under 18 years of age admitted to National Taiwan University Hospital due to ALF from 2003 to 2016 were included in this retrospective analysis.. Among the patients, 11 (48%) had native liver recovery (NLR), 9 (39.1%) died without liver transplant, and 3 (12.9%) received liver transplantation. The NLR group showed a lower proportion of idiopathic cases, lower peak ammonia level, higher peak alpha fetoprotein (AFP) level, and they had plasma exchange fewer times than the other groups. Receiver operating characteristic curve analyses yielded optimal cutoff values of plasma exchange (≤6 times), peak ammonia level (<190 μmol/L), and peak AFP level for predicting NLR in children with ALF.. Pediatric ALF with idiopathic etiology, high peak ammonia level, and low peak AFP level are associated with fewer cases of NLR. Plasma exchange for more than six times probably offers little benefit with regard to patient survival if liver transplantation is not performed promptly.

Topics: Adolescent; alpha-Fetoproteins; Ammonia; Antithyroid Agents; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Female; Hemochromatosis; Hepatitis, Viral, Human; Hepatolenticular Degeneration; Humans; Infant; Infant, Newborn; Liver Failure, Acute; Liver Transplantation; Lymphohistiocytosis, Hemophagocytic; Male; Metabolism, Inborn Errors; Mortality; Plasma Exchange; Prognosis; Propylthiouracil; Recovery of Function; Retrospective Studies; ROC Curve; Taiwan

Liver transplantation (LT) for acute liver failure is an uncommon occurrence in the setting of pregnancy given the risk of fetal demise, and rarely is it undertaken with a viable fetus. Maternal hyperthyroidism increases fetal risk in the setting of LT, particularly in the setting of thyrotoxicosis. We report the first case of propylthiouracil-induced acute liver failure in a hyperthyroid patient in her second trimester resulting in LT. The multidisciplinary management led to a favorable outcome for the patient and the subsequent delivery of a healthy infant at 38-weeks' gestation.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Live Birth; Liver Failure, Acute; Liver Transplantation; Pregnancy; Pregnancy Complications; Propylthiouracil

Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presenting with renal failure, acute hepatic failure, and cerebral angiitis is a rare yet fatal disease. Early diagnosis and management may help in reducing mortality and morbidity. Plasmapheresis and induction with either cyclophosphamide or rituximab is indicated. Understanding the pathophysiology and complex management of this disease poses challenges to clinicians.. A 42-year-old woman presented with acute renal and hepatic failure. She had been on PTU for 11 months for Graves' disease. Initial urine microscopy showed red blood cell casts. Anti PR-3 antibodies were positive. Kidney biopsy revealed pauci-immune glomerulonephritis with crescent formation. Renal and hepatic failures were attributed to PTU-induced c-ANCA production as other serological workup was negative. Pulse steroids and plasmapheresis were initiated. Later she developed pneumonia. She was also given rituximab. After the first dose of rituximab, plasmapheresis was held for 3 days. The second dose of rituximab was given in 5 days owing to removal by plasmapheresis. She got 8 sessions of plasmapheresis. She also developed seizures and MRA of her head revealed cerebral infarct, with findings suggestive of cerebral angiitis. She did not recover and expired 20 days after presentation.. PTU can cause ANCAassociated vasculitis resulting in multiorgan failure. Plasmapheresis should be held for 3 days after rituximab infusion in order to allow maximum exposure. The second dose of rituximab may be given before the recommended 7-day interval in cases in which plasmapheresis is being performed to maximize therapeutic benefit.

Topics: Adult; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Monoclonal, Murine-Derived; Antithyroid Agents; Biopsy; Combined Modality Therapy; Disease Progression; Fatal Outcome; Female; Glomerulonephritis; Graves Disease; Humans; Immunosuppressive Agents; Liver Failure, Acute; Magnetic Resonance Angiography; Microscopy, Electron; Multiple Organ Failure; Plasmapheresis; Propylthiouracil; Pulse Therapy, Drug; Rituximab; Steroids; Time Factors; Treatment Failure; Vasculitis, Central Nervous System

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Hyperthyroidism; Liver Failure, Acute; Liver Transplantation; Methimazole; Propylthiouracil

Topics: Antithyroid Agents; Child; Female; Humans; Hyperthyroidism; Liver Failure, Acute; Propylthiouracil

Propylthiouracil is a commonly used medication for hyperthyroidism. Though propylthiouracil-induced hepatotoxicity is a rarely encountered problem, death due to fulminant hepatic failure may occur. In the English literature, only 34 cases have been described with severe hepatotoxicity secondary to this drug. Here we report a case of fulminant hepatic failure due to propylthiouracil and review the issues of treatment and management with special emphasis on the use of plasmapheresis in such situations.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Liver Failure, Acute; Plasmapheresis; Propylthiouracil

Topics: Antithyroid Agents; Carbimazole; Humans; Jaundice, Obstructive; Liver Failure, Acute; Propylthiouracil; Thyrotoxicosis

Acute hepatic failure is a rare and potentially lethal complication of propylthiouracil (PTU) use for hyperthyroidism. We present a 20-year-old woman with Basedow-Graves' disease who developed PTU-induced fulminant hepatitis, which progressed to acute hepatic failure with grade III hepatic encephalopathy. Laboratory evaluation ruled out the most common causes of fulminant hepatitis. We treated her hyperthyroidism with amiodarone (average daily dose, 200 mg) for 3 weeks, achieving rapid and persistent euthyroidism, (triiodothyronine [T(3)] levels ranged between 64 and 109 ng/dL) without side effects. Amiodarone treatment did not abolish the thyroid radioactive iodine uptake (RAIU), allowing for subsequent treatment with radioactive iodine. The clinical course was favorable and the patient achieved full hepatic recovery 3 months after the hepatic failure was detected. After an extensive review of the literature, we believe that this is the first communication of the successful use of amiodarone to control hyperthyroidism in a patient with PTU-induced fulminant hepatitis.

Topics: Adult; Amiodarone; Female; Humans; Hyperthyroidism; Liver Failure, Acute; Propylthiouracil; Triiodothyronine

Topics: Adolescent; Female; Graves Disease; Humans; Liver Failure, Acute; Liver Transplantation; Propylthiouracil

A 36-year-old Chinese man presented to the Queen Mary Hospital in August 1999 with a 2-week history of jaundice due to propylthiouracil treatment for thyrotoxicosis. He had previously received carbimazole but had developed an urticarial skin rash after 2 weeks of treatment. The patient developed liver failure and fulminant pneumonitis shortly after hospital admission. Despite receiving treatment with broad-spectrum antibiotics and intravenous immunoglobulin, he died 11 days after the onset of the respiratory symptoms. Postmortem examination using electron microscopy showed typical glycogen bodies within the cytoplasm of the hepatocytes, which corresponded to eosinophilic cytoplasmic inclusion bodies visible under light microscopy. Immunohistochemical studies of the inclusion bodies were positive for carcinoembryonic antigen and albumin, and negative for fibrinogen, complement protein C3, immunoglobulins G, M, and A, alpha-fetoprotein, and alpha-1-antitrypsin. This is the first report of a patient who received two sequential antithyroid drugs and developed predominate cholestasis with unique histological features. Extreme caution should be taken when a patient develops allergy to one type of antithyroid drug, because cross-reactivity may develop to the other type.

Topics: Adult; Antithyroid Agents; Carbimazole; Drug Administration Schedule; Fatal Outcome; Humans; Jaundice, Obstructive; Liver Failure, Acute; Male; Propylthiouracil; Thyrotoxicosis

Topics: Adult; Antithyroid Agents; Biopsy; Chemical and Drug Induced Liver Injury; Female; Graves Disease; Humans; Liver Failure, Acute; Liver Function Tests; Propylthiouracil