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Atovaquone/proguanil-induced autoimmune-like hepatitis
Benedetta Terziroli Beretta-Piccoli1, Giorgina Mieli-Vergani2, Raffaela Bertoli3
1Epatocentro Ticino Lugano Switzerland.
Hepatology Communications
|February 7, 2018
Summary
A rare case links the antimalarial atovaquone/proguanil to drug-induced autoimmune-like hepatitis. Prompt diagnosis and steroid treatment led to full recovery, highlighting the drug
Area of Science:
- Hepatology
- Clinical Pharmacology
- Immunology
Background:
- Autoimmune hepatitis is a chronic liver disease of unknown etiology.
- Drug-induced liver injury (DILI) can mimic autoimmune hepatitis.
- Atovaquone/proguanil is a widely prescribed antimalarial and anti-toxoplasmosis medication.
Purpose of the Study:
- To report a novel association between atovaquone/proguanil and drug-induced autoimmune-like hepatitis.
- To highlight the potential for drug rechallenge to trigger severe liver disease.
- To emphasize the importance of considering medication history in diagnosing autoimmune hepatitis.
Main Methods:
- Case report of a patient developing severe liver disease.
- Biochemical, immunologic, and histologic evaluation for autoimmune hepatitis.
- Liver biopsy assessment before and after treatment.
- Monitoring of patient's response to steroid therapy and drug withdrawal.
Main Results:
- The patient developed severe liver disease fulfilling criteria for autoimmune hepatitis after rechallenge with atovaquone/proguanil.
- Liver biopsies showed progressive resolution of inflammation over 18 months.
- Complete biochemical and immunologic remission was achieved with steroids and persisted after withdrawal.
Conclusions:
- Atovaquone/proguanil can be associated with drug-induced autoimmune-like hepatitis.
- This case underscores the potential hepatotoxicity of atovaquone/proguanil.
- Early recognition and management are crucial for favorable outcomes in drug-induced liver injury.
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