[Asymptomatic diclofenac-induced acute hepatitis].
METHODS
After removal of an herniated intervertebral disc a 49-year-old man had recurrent pain in the lumbar region, treated with diclofenac and flupirtine. 4 months postoperatively he was referred to the author's hospital because of progressive rise in transaminase levels and in cholestasis parameters. Physical examination on admissions was unremarkable, except for jaundice.


METHODS
Laboratory tests showed an increases in transaminases (GPT 769 U/l [normal: < 23 U/l], GOT 285 U/l [normal: < 19 U/l]) and in cholestasis-related values (gamma-GT 172 U/l [Norm 6-28 U/l], alkaline phosphatase 207 U/l [normal < 175 U/l], total bilirubin: 2.5 mg/dl [Norm < 1.1 mg/dl]). This corresponded to the histological finding of toxic damage to the liver parenchyma. Viral, autoimmune and metabolic causes had been excluded. DIAGNOSES, TREATMENT AND COURSE: The history as well as laboratory and histological findings indicated diclofenac-induced toxic hepatitis. The drug was discontinued and without any treatment all laboratory values returned to normal within 9 weeks.


CONCLUSIONS
Diclofenac, a frequently prescribed non-steroid anti-inflammatory drug, is generally thought to be relatively safe. But it can produce toxic hepatitis which may be asymptomatic (but this patient was jaundiced) and may take an unforeseeable course. This should be taken account of by regularly monitoring liver functions.
Dierkes-Globisch
A
A
Abteilung I, Innere Medizin, Bundeswehrzentralkrankenhaus Koblenz.
Schäfer
R
R
Mohr
H H
HH
D000208:Acute Disease; D000631:Aminopyridines / Q000009:adverse effects; D000700:Analgesics / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001707:Biopsy, Needle; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004008:Diclofenac / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000150:complications / Q000188:drug therapy; D012008:Recurrence
D000631:Aminopyridines; D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; C034161:flupirtine