title: Propylthiouracil-associated liver failure presenting as probable autoimmune hepatitis in a child with Graves' disease.
abstract: This case describes a young girl with Graves' disease, who presented with fulminant hepatic failure 9 months into propylthiouracil (PTU) therapy. Her clinical presentation was consistent with 'probable autoimmune hepatitis,' as defined by the International Autoimmune Hepatitis Group scoring system. Despite discontinuation of PTU and high-dose steroid therapy, she required liver transplantation. Subsequent pathology could not definitively rule out autoimmune hepatitis. PTU is an important cause of drug-related liver failure in children, and clinicians should be mindful that it is frequently used in patients who already have an underlying risk of autoimmune liver disease.
authors.affiliation: Department of Pediatrics, UCSF, San Francisco, CA, USA.
authors.forename: Walter E B
authors.initials: WE
authors.lastname: Sipe
authors.forename: Maureen
authors.initials: M
authors.lastname: Su
authors.forename: Andrew
authors.initials: A
authors.lastname: Posselt
authors.forename: Grace E
authors.initials: GE
authors.lastname: Kim
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Quiros
authors.forename: Philip
authors.initials: P
authors.lastname: Rosenthal
mesh_terms: D013956:Antithyroid Agents / Q000627:therapeutic use*; D002102:Cadaver; D002648:Child; D005260:Female; D006111:Graves Disease / Q000188:drug therapy*; D019693:Hepatitis, Autoimmune / Q000209:etiology*; D006801:Humans; D007902:Length of Stay; D017093:Liver Failure / Q000209:etiology* / Q000473:pathology; D016031:Liver Transplantation; D011441:Propylthiouracil / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D011441:Propylthiouracil