Acute Liver Failure in a Patient Treated With Metamizole

Philipp Krisai; Deborah Rudin; David Grünig; Kathrin Scherer; Werner Pichler; Luigi Terracciano; Stephan Krähenbühl

doi:10.3389/fphar.2019.00996

Acute Liver Failure in a Patient Treated With Metamizole

Front Pharmacol. 2019 Sep 11:10:996. doi: 10.3389/fphar.2019.00996. eCollection 2019.

Authors

Philipp Krisai¹, Deborah Rudin², David Grünig², Kathrin Scherer³, Werner Pichler⁴, Luigi Terracciano⁵, Stephan Krähenbühl²

Affiliations

¹ Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
² Division of Clinical Pharmacology & Toxicology, University Hospital Basel, Basel, Switzerland.
³ Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
⁴ ADR-AC GmbH, Berne, Switzerland.
⁵ Institute of Pathology, University Hospital Basel, Basel, Switzerland.

Abstract

We report on a patient who developed acute liver failure while being treated with metamizole. After liver transplantation, the patient recovered rapidly. Liver biopsy showed massive necrosis and lobular infiltration of lymphocytes. A lymphocyte transformation test performed 20 months after transplantation was positive for metamizole. In vitro investigations with N-methyl-4-aminoantipyrine (MAA) and 4-aminoantipyrine (AA), the two active metabolites of metamizole, did not reveal relevant toxicity in HepG2 and HepaRG cells. The demonstration of activated lymphocytes by the lymphocyte transformation test and the absence of relevant cytotoxicity by MAA and AA in hepatocyte cell lines suggest an immunological mechanism of metamizole-associated hepatotoxicity.

Keywords: 4-aminoantipyrine (AA); N-methyl-4-aminoantipyrine (MAA); liver failure; lymphocyte transformation test (LTT); metamizole.

Publication types

Case Reports