Fulminant hepatic failure secondary to hydroxychloroquine

Area of Science:

• Hepatology
• Rheumatology
• Clinical Pharmacology

Background:

• Hydroxychloroquine is a common treatment for various rheumatological conditions.
• Potential adverse effects of hydroxychloroquine are well-documented, but hepatic side effects are considered rare.
• Fulminant hepatic failure (FHF) is a critical condition with high mortality.

Observation:

• Two cases of FHF are presented in patients initiating hydroxychloroquine therapy for chronic rheumatological disorders.
• Liver disease symptoms emerged within two weeks of starting hydroxychloroquine treatment.
• Neither patient had any prior history of liver disease.

Findings:

• Hydroxychloroquine initiation was temporally associated with the rapid onset of FHF in both cases.
• The severity of liver injury progressed quickly, leading to critical illness.
• One patient underwent emergency liver transplantation; the other succumbed to liver failure.

Implications:

• This study suggests a potential causal link between hydroxychloroquine and FHF, challenging previous assumptions about its hepatic safety profile.
• Clinicians should consider hydroxychloroquine-induced liver injury in patients presenting with acute liver failure, especially those with rheumatological conditions.
• Enhanced vigilance and monitoring of liver function may be warranted for patients on hydroxychloroquine therapy.