Liver failure associated with benzbromarone:A case report and review of the literature

BACKGROUND Benzbromarone is a uricosuric agent that reduces proximal tubular reabsorption of uric acid.Because of hepatotoxicity,it has been withdrawn from the market in Europe.Recently,some benefit-risk assessments of benzbromarone suggest that benzbromarone has greater benefits than risks,and the application of benzbromarone in the treatment of gout and hyperuricemia is still under debate.CASE S UMMARY A 39-year-old man was admitted to the hospital for icterus and nausea,and he was treated with benzbromarone(100 mg/d)for 4 mo because of hyperuricemia He had a 10-year history of beer drinking(alcohol:about 28 g/d).Laboratory data showed severe liver injury and serious coagulation dysfunction;tests for autoimmune antibodies,viral hepatitis,and human immunodeficiency virus were negative.Despite administration of liver function-protecting drugs and efficient supportive treatment,the patient deteriorated quickly after hospitalization and developed grade Ⅱ encephalopathy within a few days.The patient accepted continuous plasma exchange six times;however,his condition did not improve.Based on suggestions from multidisciplinary consultation,the patient underwent liver transplantation 26 d after admission.Liver specimen pathology results showed massive necrosis consistent with drug-induced liver injury,supporting the diagnosis of acute liver failure associated with benzbromarone.The patient recovered quickly thereafter.CONCL USION This case highlights that clinicians should be on the alert for the severe hepatotoxicity of benzbromarone.Before prescribing benzbromarone,physicians should evaluate the high-risk factors that may lead to liver injury and provide suggestions for monitoring benzbromarone’s hepatotoxicity during treatment.

Hepatitis B virus-related liver cirrhosis complicated with dermatomyositis: A case report

BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated with some autoimmune disorders.Dermatomyositis(DM)is an idiopathic inflammatory myopathy,which involves a viral infection,and DM has been identified in patients infected with HBV,but there is no direct histological evidence for an association between HBV and DM.CASE SUMMARY We describe a familial HBV-infected patient admitted with liver function abnormality,rashes,a movement disorder,and an elevated level of creatine kinase(CK).A computed tomography scan of the lung showed pulmonary fibrosis,and a liver biopsy identified nodular cirrhosis.An electromyogram revealed myogenic damage,and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells.Immunohistochemical staining showed negative results for HBsAg and HBcAg.Fluorescence in situ hybridization showed a negative result for HBV DNA.The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone,mycophenolate mofetil,and lamivudine.Eight months later,the patient was readmitted for anorexia and fatigue.The blood examination showed elevated levels of aminotransferases and HBV DNA,however,the CK level was within the normal range.The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.CONCLUSION DM in chronic HBV-infected patients does not always associate with HBV.Antiviral and immunosuppressive drugs should be taken into consideration.

IgG4-related autoimmune pancreatitis overlapping with Mikulicz's disease and lymphadenitis:A case report

Autoimmune pancreatitis(AIP)is a form of chronic pancreatitis that is categorized as type 1 or type 2according to the clinical profile.Type 1 AIP,which predominantly presents in a few Asian countries,is a hyper-IgG4-related disease.We report a case of IgG4-related AIP overlapping with Mikulicz’s disease and lymphadenitis,which is rare and seldom reported in literature.A 63-year male from Northeast China was admitted for abdominal distension lasting for one year.He presented symmetric swelling of the parotid and submandibular glands with slight dysfunction of salivary secretion for 6 mo.He had a 2-year history of bilateral submandibular lymphadenopathy without pain.He underwent surgical excision of the right submandibular lymph node one year prior to admission.He denied any history of alcohol,tobacco,or illicit drug use.Serological examination revealed high fasting blood sugar level(8.8 mmol/L)and high level of IgG4(15.2 g/L).Anti-SSA or anti-SSB were negative.Computed tomography of the abdomen showed a diffusely enlarged pancreas with loss of lobulation.Immunohistochemical stain for IgG4 demonstrated diffuse infiltration of IgG4-positive plasma cells in labial salivary gland and lymph node biopsy specimens.The patient received a dose of 30 mg/d of prednisone for three weeks.At this three-week follow-up,the patient reported no discomfort and his swollen salivary glands,neck lymph node and pancreas had returned to normal size.The patient received a maintenance dose of 10mg/d of prednisone for 6 mo,after which his illness had not recurred.