Autoimmune hepatitis unmasked by nimesulide

Area of Science:

• Hepatology
• Toxicology
• Immunology

Background:

• Drug-induced liver injury (DILI) is a significant cause of acute liver failure.
• Nimesulide, a non-steroidal anti-inflammatory drug, has been associated with hepatotoxicity.
• Distinguishing DILI from autoimmune hepatitis (AIH) can be challenging.

Observation:

• A 49-year-old woman developed acute hepatic failure 2 weeks after nimesulide use, presenting with a high MELD score.
• Initial treatment with supportive care and N-acetylcysteine showed clinical improvement.
• Liver biopsy revealed micronodular cirrhosis with acute hepatitis, suggestive of AIH.

Findings:

• Immunosuppressive therapy with azathioprine and prednisolone was initiated.
• Prednisolone was gradually tapered over several months.
• A follow-up liver biopsy after 28 months demonstrated near-complete remission with minimal fibrosis and inflammation.

Implications:

• This case underscores the potential for nimesulide to trigger autoimmune-like hepatitis.
• Early diagnosis and immunosuppressive treatment are crucial for managing severe DILI.
• Successful treatment can lead to significant recovery, even in cases initially presenting as acute liver failure.