Ornidazole-induced autoimmune hepatitis

Area of Science:

• Hepatology
• Clinical Pharmacology
• Immunology

Background:

• Ornidazole is a widely used antiparasitic medication for treating infections like amoebiasis, giardiasis, and trichomoniasis.
• Autoimmune hepatitis (AIH) and AIH-like syndromes have been increasingly associated with various drug classes, including antibiotics.

Observation:

• A case study involving a 35-year-old woman presenting with recurrent episodes suggestive of drug-induced liver injury.
• The patient had been prescribed ornidazole for the treatment of diarrhea and a vaginal infection.

Findings:

• The patient experienced two distinct relapses of autoimmune hepatitis (AIH).
• Both AIH relapses were temporally linked to the prescription and use of ornidazole.
• This suggests a causal relationship between ornidazole and the development of AIH in this patient.

Implications:

• This case highlights a potential, previously underreported adverse effect of ornidazole, specifically drug-induced autoimmune hepatitis.
• Clinicians should consider ornidazole as a potential trigger for AIH, especially in cases of unexplained liver enzyme elevations or AIH-like presentations.
• Further investigation into the immunopathogenesis of ornidazole-induced AIH is warranted to improve patient safety and management strategies.