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Drug-Induced Hepatitis in Children: The Experience of a Single Center in Romania
Irina Dijmărescu1,2, Oana Maria Guță1, Livia Elena Brezeanu1
1Department of Pediatrics, "Grigore Alexandrecu" Emergency Children's Hospital, 011743 Bucharest, Romania.
Insights
Drug-induced liver injury (DILI) in children is uncommon but serious. Paracetamol and albendazole were the main causes, with most cases being mild and no deaths reported.
Area of Science:
- Pediatric Hepatology
- Toxicology
- Drug Safety
Background:
- Drug-induced liver injury (DILI) is a rare but potentially fatal condition.
- Acute liver disease in children presents diagnostic challenges.
- Identifying causative agents is crucial for management and prevention.
Purpose of the Study:
- To investigate the incidence, clinical features, and outcomes of DILI in pediatric patients.
- To identify common drugs associated with DILI in children.
- To analyze the patterns and severity of DILI in a pediatric cohort.
Main Methods:
- Retrospective analysis of pediatric patients with acute liver disease over six years.
- Identification and classification of DILI cases based on drug exposure.
- Clinical data, laboratory values, and DILI severity index were analyzed.
Main Results:
- 40 out of 2533 children had DILI, primarily linked to paracetamol and albendazole.
- Adolescents (13-17 years) were most affected; gastrointestinal symptoms and jaundice were common.
- Hepatocellular injury was most frequent (70%), with mild DILI in 81% and no reported deaths.
Conclusions:
- Paracetamol and albendazole are significant causes of DILI in children.
- While often mild, DILI diagnosis requires excluding other liver disease causes.
- This study highlights the importance of monitoring for DILI in pediatric populations.
Abstract:
Drug-induced liver injury (DILI) is uncommon but potentially lethal. Over 6 years, 2533 children with acute liver disease were identified in our center, 48 of which suffered from toxic hepatitis, and 40 exhibited DILI (22 paracetamol-related, 14 albendazole-related). The most affected children were in the 13-17-year-old age group. The mean time between drug ingestion and disease diagnosis was 25.4 h for paracetamol-related DILI and 21.6 days for the albendazole-related group. Clinical features were mostly gastrointestinal, jaundice being reported in 30% of the cases. Regarding the type of liver injury, for 70% of the patients it was hepatocellular (mostly paracetamol toxicity), for 11% cholestatic, and for 19% mixed (albendazole-related). The mean initial ALT value was 1020 U/L for all DILIs. Coagulopathy was only identified for the acetaminophen-related group. The median number of hospitalization days was 6.9 for DILI related to acetaminophen ingestion, compared with 7 for the idiosyncratic pattern. When applying the DILI severity index, 81% of the patients were categorized as having a mild hepatic ailment, while 19% had a moderate-severe or severe disease. No deaths were reported in the study group. The diagnosis of DILI involves the exclusion of other causes of liver injury; therefore, it is considered one of the most challenging diagnoses in hepatology.
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