About the journal

Cobiss

Srpski arhiv za celokupno lekarstvo 2019 Volume 147, Issue 7-8, Pages: 479-483
https://doi.org/10.2298/SARH171124036M
Full text ( 196 KB)


Severe toxic acute liver injury

Mitrović Nikola ORCID iD icon (Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia)
Bojović Ksenija (Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade)
Simonović Jasmina (Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade)
Nikolić Nataša (Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia)
Urošević Aleksandar (Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade)
Delić Dragan (Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade)

Introduction. Toxic liver injury is becoming greater problem in today´s hepatology. Until today more than 900 drugs, toxins and herbs have been identified that can cause different liver injury. There was no significant research of this problem in Serbia so far. The aim of this study is to present the patient with severe form of acute hepatitis, whose etiology is exclusively toxic. Case outline. A 23-year-old male, from Belgrade, previously healthy, got sick with signs and symptoms that correlated with acute hepatitis. Biochemical analyses pointed to severe form of acute hepatitis with impending hepatocellular failure. The diagnosis of toxic liver injury was set. It was caused by the use of number substances and supplements: ecstasy, whey protein, branched-chain amino acid (BCAA), creatine, high doses of vitamin D, glutamine, and multivitamin complex. He was treated with infusion, gastroprotective, and substitution therapy. During hospitalization, the patient’s symptoms disappeared with gradual normalization of biochemical analyses of the liver. When the patient’s condition was satisfying, blind percutaneous liver biopsy was performed, with the following pathohistological findings: lobular hepatitis, with no fibrosis, etiology correlates to toxic. After a month and a half since the disease had begun, the patient fully recovered. Conclusion. Increased number of persons with toxic liver injury is being registered in developed countries worldwide. Similar trend can be noted in Serbia as well. By presenting young previously healthy man with the severe form of toxic acute hepatitis and impending liver failure, we are pointing out the significance of this problem. Multidisciplinary approach is needed to reach the most effective solutions.

Keywords: acute hepatitis, toxic liver injury, toxins, supplements