doiSerbia

Cholestatic hepatitis associated with nimesulide: A case report

Lukić Snežana (Klinika za gastroenterologiju i hepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Krstić Miodrag (Klinika za gastroenterologiju i hepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Damjanov Nemanja (Institut za reumatologiju, Beograd)
Boričić Ivan (Institut za patologiju, Medicinski fakultet, Beograd)
Popović Dragan (Klinika za gastroenterologiju i hepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Đuranović Srđan (Klinika za gastroenterologiju i hepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Kovačević Nada (Klinika za gastroenterologiju i hepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Tomanović Nada (Institut za patologiju, Medicinski fakultet, Beograd)

Introduction A toxic effect of drugs, including non-steroidal anti-inflammatory drugs, may be one of aetiological factors for the occurrence of acute hepatitis. Nimesulide is a selective cyclooxygenase-2 inhibitor, whose adverse effects on the liver range from acute hepatitis to more serious conditions, involving the development of acute liver failure and fatal outcome. Case Outline A female patient, aged 73, was admitted to the Gastroenterology and Hepatology Clinic of the Clinical Centre of Serbia in Belgrade because of liver failure. Due to the pain in the right knee, she received a therapy of 100 mg nimesulide in tablets, two times a day, for two months before admission to the Clinic. The analysis of the results of clinical, laboratory and radiographic examinations, and of histopathological findings of the liver biopsy showed that acute hepatitis was associated with the administration of nimesulide. Once the patient discontinued the intake of this drug, she fully convalesced. Conclusion The patient who received nimesulide over a period of two months developed acute hepatitis. In view of the similar cases described in literature and the fact that the use of nimesulide has been discontinued in a number of European countries and restricted by the European Medicines Agency, restriction or ban on the use of nimesulide on the Serbian market should be considered.

Keywords: cholestatic hepatitis, non-steroidal anti-inflammatory drugs, nimesulide, hepatotoxicity