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Indian Pediatr 2013;50: 1064 |
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Albendazole-induced Recurrent Hepatitis
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Madhumita Nandi and Sumantra Sarkar
Department of Pediatrics, Institute of Post Graduate
Medical Education and Research, Kolkata 700 020, West Bengal, India.
Email:
[email protected]
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A 5-year-old male child presented with repeated episodes of
acute-hepatitis, each episode occurring after 2-3 days of
administering albendazole. He presented to us during the
fourth such episode with complaints of acute onset fever,
anorexia and vomiting followed by yellowish discoloration of
eyes and urine. Each episode lasted 2-3 weeks, the
intervening periods remaining uneventful. Liver was palpable
3.5 cm below the right costal margin. It was mildly tender
and soft. There were no signs of chronic liver disease.
Serum bilirubin on admission was 11.5 mg/dL(Direct- 9.5 and
indirect-2.0). Serum alanine transaminase, aspartate
transaminase, alkaline phos-phatase and gamma glutamyl
transpeptidase (GGT) were 2720 IU/L, 4100 IU/L, 1247 IU/L
and 26 IU/L, respectively. Albumin and globulin levels were
3.3 g/dL and 3.0 g/dL, respectively. Prothrombin time was 22
seconds (INR-1.6, control 12.6 secs) and aPTT was 31.0 secs
(N-25-35 sec). Ceruloplasmin level was 35.64 mg/dL (N >20
mg/dL). HBsAg, anti HCV Ab, IgM HAV and IgM HEV, antinuclear
antibodies, anti LKM antibody and anti smooth muscle
antibody were negative. His condition improved within 2
weeks with subsidence of jaundice and hepatomegaly. On
follow up, at 2 months, he was asymptomatic without
hepatomegaly and with normal levels of bilirubin.
Albendazole (methyl
5-propylthio-2-benzimidazole-carbamate) is a widely used
broad spectrum antihelminthic drug. Mild adverse effects
like nausea, vomiting and pruritus have been occasionally
reported [1]. However, reports of albendazole induced
significant liver toxicity are rare. Moreover, most of the
previous incidences have been reported following prolonged
administration [1]. Recurrent hepatitis following single
dose administration of albendazole is rare [2].
As all the common etiological markers of
chronic and recurrent hepatitis were negative and due to
temporal relation of albendazole ingestion with onset of
self-limiting clinical jaundice four times in two years, a
possibility of albendazole induced idiosyncratic
hepatotoxicity was considered. He scored 5 on Naranjo Scale
[3], categorizing as probable ADR. On Roussel Uclaf
Causality Assessment Method of the Council for International
Organizations of Medical Sciences scale [4,5], this child
scored 9 points categorizing as highly probable
association of albendazole with DILI (drug induced liver
injury).
We, as clinicians, need to be aware of
this rare but significant adverse effect of this commonly
and often empirically used drug.
References
1. Gozukucuk R, Abci I, Gluclu M.
Albendazole-induced toxic hepatitis: A case report. Turk J
Gastroenterol. 2013;24:82-3.
2. Shah C, Mahapatra A, Shukla A, Bhatia
S. Recurrent acute hepatitis caused by albendazole. Trop
Gastroenterol. 2013;34:38-9.
3. Naranjo CA, Busto U, Sellers EM, Sandor
P, Ruiz I, Roberts EA, et al. A method for estimating
the probability of adverse drug reactions. Clin Pharmacol
Ther. 1981;30:239-45.
4. Danan G, BeŽnichou C. Causality
assessment of adverse reactions to drugs: I. A novel method
based on the conclusions of international consensus
meetings: application to drug-induced liver injuries. J Clin
Epidemiol. 1993;46:1323-30.
5. BeŽnichou C, Danan G, Flahault A. Causality assessment
of adverse reactions to drugs: II. An original novel or
validation of drug causality assessment methods: case
reports with positive rechallenge. J Clin Epidemiol.
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