Successful treatment of drug-induced acute liver failure with high-volume plasma exchange.
We report two patients with drug-induced liver injury (DILI)-related acute liver failure (ALF) who were successfully treated with high-volume plasma exchange without liver transplantation. The first patient was a 66-year-old man admitted because of a perforated duodenal ulcer complicated with peritonitis and septic shock. After treatment with multiple antibiotics, the patient developed DILI and ALF. Grade 3 hepatic encephalopathy and profound jaundice were present. Symptoms and signs of ALF improved dramatically after initiation of plasma exchange. The patient was discharged uneventfully. The second patient was a 94-year-old man admitted for treatment of newly diagnosed pulmonary tuberculosis. DILI and ALF developed 5 days after initiation of anti-tuberculosis treatment. Grade 4 hepatic encephalopathy was present. After plasma exchange, the patient's level of consciousness improved dramatically, and he recovered from ALF. These 2 cases show the potential of plasma exchange in the treatment of DILI despite occurrence acute liver failure.
Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Chung-Te
CT
Liu
Tso-Hsiao
TH
Chen
Chung-Yi
CY
Cheng
D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications*; D003428:Cross Infection / Q000209:etiology; D004381:Duodenal Ulcer / Q000150:complications / Q000601:surgery; D017809:Fatal Outcome; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D017093:Liver Failure / Q000209:etiology / Q000628:therapy*; D008297:Male; D010538:Peritonitis / Q000188:drug therapy; D010949:Plasma; D010951:Plasma Exchange / Q000379:methods; D010952:Plasma Substitutes / Q000627:therapeutic use; D011014:Pneumonia / Q000209:etiology; D012772:Shock, Septic / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
acute liver failure; artificial liver support; drug-induced liver injury; plasma exchange