Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine
Key Clinical Message Clinicians in tuberculosis and dengue endemic regions should have heightened vigilance for drug‐induced liver injury (DILI) overlapping with active infections, enabling prompt recognition and life‐saving conservative management. Abstract Severe dengue and drug‐induced liver inju...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Clinical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ccr3.8578 |
| _version_ | 1797244345723650048 |
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| author | Naveen Gautam Nishan Shrestha Sanjeev Bhandari Sabin Thapaliya |
| author_facet | Naveen Gautam Nishan Shrestha Sanjeev Bhandari Sabin Thapaliya |
| author_sort | Naveen Gautam |
| collection | DOAJ |
| description | Key Clinical Message Clinicians in tuberculosis and dengue endemic regions should have heightened vigilance for drug‐induced liver injury (DILI) overlapping with active infections, enabling prompt recognition and life‐saving conservative management. Abstract Severe dengue and drug‐induced liver injury (DILI) are significant independent risk factors for acute liver failure. The co‐occurrence of these conditions significantly complicates clinical management. Here, we describe the case of a 21‐year‐old Nepali female who developed acute liver failure during antitubercular therapy (ATT). The patient, presenting with fever and nausea after 3 weeks of ATT, subsequently received a diagnosis of severe dengue. Laboratory evidence indicated markedly elevated transaminases (AST 4335 U/L, ALT 1958 U/L), total bilirubin (72 μmol/L), and INR (>5). Prompt discontinuation of first‐line ATT, initiation of a modified ATT regimen, and N‐acetylcysteine (NAC) infusion facilitated the patient's recovery after a week of intensive care. This case underscores the potential for synergistic hepatotoxicity in regions where multiple endemic illnesses coincide. Early recognition of DILI, cessation of offending agents, and comprehensive intensive care are crucial interventions. While the definitive efficacy of NAC remains under investigation, its timely administration in these complex cases warrants exploration for its potential lifesaving benefits. |
| first_indexed | 2024-04-24T19:09:32Z |
| format | Article |
| id | doaj.art-716701c0da4742e5a5bd4249b35f6a56 |
| institution | Directory Open Access Journal |
| issn | 2050-0904 |
| language | English |
| last_indexed | 2024-04-24T19:09:32Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj.art-716701c0da4742e5a5bd4249b35f6a562024-03-26T12:36:43ZengWileyClinical Case Reports2050-09042024-03-01123n/an/a10.1002/ccr3.8578Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteineNaveen Gautam0Nishan Shrestha1Sanjeev Bhandari2Sabin Thapaliya3Maharajgunj Medical Campus Kathmandu NepalMaharajgunj Medical Campus Kathmandu NepalDepartment of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu NepalDepartment of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu NepalKey Clinical Message Clinicians in tuberculosis and dengue endemic regions should have heightened vigilance for drug‐induced liver injury (DILI) overlapping with active infections, enabling prompt recognition and life‐saving conservative management. Abstract Severe dengue and drug‐induced liver injury (DILI) are significant independent risk factors for acute liver failure. The co‐occurrence of these conditions significantly complicates clinical management. Here, we describe the case of a 21‐year‐old Nepali female who developed acute liver failure during antitubercular therapy (ATT). The patient, presenting with fever and nausea after 3 weeks of ATT, subsequently received a diagnosis of severe dengue. Laboratory evidence indicated markedly elevated transaminases (AST 4335 U/L, ALT 1958 U/L), total bilirubin (72 μmol/L), and INR (>5). Prompt discontinuation of first‐line ATT, initiation of a modified ATT regimen, and N‐acetylcysteine (NAC) infusion facilitated the patient's recovery after a week of intensive care. This case underscores the potential for synergistic hepatotoxicity in regions where multiple endemic illnesses coincide. Early recognition of DILI, cessation of offending agents, and comprehensive intensive care are crucial interventions. While the definitive efficacy of NAC remains under investigation, its timely administration in these complex cases warrants exploration for its potential lifesaving benefits.https://doi.org/10.1002/ccr3.8578anti‐tubercular therapydenguedrug‐induced liver injuryN‐acetylcysteine |
| spellingShingle | Naveen Gautam Nishan Shrestha Sanjeev Bhandari Sabin Thapaliya Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine Clinical Case Reports anti‐tubercular therapy dengue drug‐induced liver injury N‐acetylcysteine |
| title | Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine |
| title_full | Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine |
| title_fullStr | Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine |
| title_full_unstemmed | Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine |
| title_short | Severe dengue infection unmasking drug‐induced liver injury: Successful management with N‐acetylcysteine |
| title_sort | severe dengue infection unmasking drug induced liver injury successful management with n acetylcysteine |
| topic | anti‐tubercular therapy dengue drug‐induced liver injury N‐acetylcysteine |
| url | https://doi.org/10.1002/ccr3.8578 |
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