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báo cáo khoa học: "Autoimmune hepatitis triggered by nitrofurantoin: a case series"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Autoimmune hepatitis triggered by nitrofurantoin: a case series | Appleyard et al. Journal of Medical Case Reports 2010 4 311 http www.jmedicalcasereports.eom content 4 1 311 jAc JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Autoimmune hepatitis triggered by nitrofurantoin a case series Sally Appleyard Ruma Saraswati David A Gorard Abstract Introduction Drugs can occasionally trigger the onset of autoimmune liver disease. Case presentation Three Caucasian women aged 65 42 and 74 years old who were receiving long-term nitrofurantoin as prophylaxis against recurrent urinary tract infections developed hepatitic liver disease. Serological auto-antibody profiles and liver histology appearances were consistent with autoimmune hepatitis. Two of the patients presented with jaundice and one required a prolonged hospital admission for liver failure. In all three patients nitrofurantoin was withdrawn and long-term immunosuppressive therapy with prednisolone and azathioprine or mycophenolate was given. The patients responded well with liver biochemistry returning to normal within a few months. Conclusions Although nitrofurantoin rarely causes autoimmune hepatitis this antimicrobial is increasingly used as long-term prophylaxis against recurrent urinary tract infection. General practitioners and urologists who prescribe long-term nitrofurantoin therapy should be aware of this adverse effect. Introduction Autoimmune liver disease is a not uncommon cause of chronic hepatitis in women. Although autoimmune destruction usually occurs without an identifiable trigger some drugs including methyldopa 1 and minocycline 2 are associated with autoimmune liver disease. The antimicrobial nitrofurantoin has also rarely been implicated in autoimmune hepatitis. We report here three patients with hepatitis in whom nitrofurantoin was felt to be etiologically important. Case 1 A 65-year-old Caucasian retired police woman developed non-specific symptoms of abdominal discomfort nausea and lethargy. She later became jaundiced with dark urine and pale .