DRUG-INDUCED LIVER INJURY ASSOCIATED WITH SKIN HYPERSENSITIVITY REACTIONS

Abstract

Drug-induced liver injury (DILI) is a liver injury that is often caused by drugs that cause liver dysfunction. Drug-Induced Hypersensitivity Syndrome (DIHS) is a severe drug reaction with skin and systemic manifestations. Anti-epileptic drugs, allopurinol, sulfonamides, antibiotics, and nevirapine are the top five drugs responsible for DILI-related DIHS. The incidence of DILI at RSUD Dr. Saiful Anwar Malang in 2013 reached 5.4%. A case was reported in 19 years-old woman came with complaints of red rashes throughout the body accompanied by fever and itching 3 days before being hospitalized. The patient was diagnosed with Meningitis and Pulmonary Tuberculosis since two months before hospitalized. Symptoms appeared after the patient took TB drugs and phenytoin for three weeks. Laboratory tests showed eosinophilia, transaminitis, hyperbilirubinemia, with Regiscar score 5 (probable DRESS). Since then, TB drugs and phenytoin have been stopped then the patient received Levofloxacin, Levetiracetam, Corticosteroid, N-acetylcysteine, and Curcuma. The signs and symptoms improved in 13 days of follow-up. DILI-related hypersensitivity reactions must be managed appropriately to prevent irreversible liver damage. The cause of DILI in this case, couldn’t be ruled out, but TB drugs and phenytoin often trigger hypersensitivity reactions.