Thiabendazole-induced acute liver failure requiring transplantation and subsequent diagnosis of polyarteritis nodosa.
Polyarteritis nodosa (PAN), a systemic necrotising vasculitis that affects medium- and small-sized arteries, has visceral involvement in 40-60% of the patients. According to the Five-Factor Score (FFS), it is associated with poor outcome. We describe a patient who underwent orthotopic liver transplantation (OLT) for severe ductopenia induced by thiabendazole that was empirically prescribed for chronic hypereosinophilia. Eleven years later, despite immunosuppressive treatment to prevent graft rejection, he developed mononeuritis multiplex; PAN was diagnosed. He also had severe recurrent ischaemic cholangitides because of post-OLT hepatic artery ligation to treat a postoperative severe haematemesis. His outcome was favourable after second OLT, under steroids, cyclophosphamide pulses and tacrolimus. In retrospect, his initial symptoms and hypereosinophilia were probably attributable to PAN.
Department of Internal Medicine, Hôpital Cochin, Referral Center for Rare Autoimmune and Systemic Diseases, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France. matthieugroh@hotmail.com
Matthieu
M
Groh
Philippe
P
Blanche
Yvon
Y
Calmus
Loïc
L
Guillevin
D000328:Adult; D000792:Angiography; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000601:surgery*; D057210:Delayed Diagnosis; D004802:Eosinophilia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D010488:Polyarteritis Nodosa / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D012086:Reoperation; D013827:Thiabendazole / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013827:Thiabendazole