Sickle cell crisis and cocaine hepatotoxicity

Area of Science:

• Hepatology
• Toxicology
• Hematology

Background:

• Hepatic dysfunction is a known complication of sickle cell crisis, but hepatic failure is rare.
• Cocaine hepatotoxicity is an emerging concern, characterized by necrosis on liver biopsy.
• Cocaine intoxication often presents with rhabdomyolysis and renal failure, frequently with fatal outcomes.

Observation:

• A patient with concurrent sickle cell crisis and cocaine intoxication developed hepatic failure.
• The patient also presented with coagulopathy and encephalopathy.
• Liver biopsy revealed focal confluent necrosis and collapse.

Findings:

• Concomitant sickle cell crisis and cocaine intoxication can lead to acute hepatic failure.
• Cocaine-induced liver injury may present with severe necrosis and coagulopathy.
• Encephalopathy can be a manifestation of severe hepatic failure in this context.

Implications:

• Cocaine intoxication must be considered in the differential diagnosis of hepatic failure in sickle cell anemia patients.
• Early recognition and management of cocaine use are crucial for patients with sickle cell disease presenting with liver dysfunction.
• This case highlights the potential for severe, synergistic organ damage from combined sickle cell crisis and cocaine toxicity.