A Case of Recent Liver Injury Induced by Benzbromarone

Tomotaka Ishii,Mariko Kumagawa,Taku Mizutani,Shini Kanezawa,Kazushige Nirei,Ryota Masuzaki,Yoichiro Yamana,Mitsuhiko Moriyama,Reina Sasaki-Tanaka,Naoki Matsumoto,Hiroaki Yamagami,Masayuki Honda,Tatsuo Kanda,Keijiro Hoshino

doi:10.3390/reports5010008

Abstract

A 39-year-old male had a stomachache for 10 days before abnormal liver function tests were detected by a local doctor. Then, he was referred to us and admitted to our hospital for examination and treatment of elevated transaminases. He had taken benzbromarone to treat his hyperuricemia for seven months, and we diagnosed him with benzbromarone-induced liver injury. After the termination of benzbromarone, he finally recovered from his illness. There are several reports about benzbromarone-induced liver injury. In conclusion, as periodic liver function tests seem not to be completely performed, clinicians should regularly monitor liver function tests in patients taking benzbromarone.

Highlights

Underexcretion of urate is the major cause of hyperuricemia in people with gout and another cause is the overproduction of urate through the purine degradation pathway [1]
Benzbromarone inhibits urate transporter 1 (URAT1), which is a major urate transporter involved in renal uric acid reabsorption and excretion [2]
Benzbromarone demonstrated a significantly greater reduction in serum uric acid levels compared with the allopurinol regimen [3]

Summary

Introduction

Underexcretion of urate is the major cause of hyperuricemia in people with gout and another cause is the overproduction of urate through the purine degradation pathway [1]. Benzbromarone inhibits urate transporter 1 (URAT1), which is a major urate transporter involved in renal uric acid reabsorption and excretion [2]. Benzbromarone has uricosuric action and normalizes serum uric acid levels [2]. Benzbromarone has been compared with allopurinol, which inhibits overproduction of urate, in chronic gout patients with renal impairment [3]. Benzbromarone demonstrated a significantly greater reduction in serum uric acid levels compared with the allopurinol regimen [3]. Acute liver injuries including acute liver failure (ALF) have occasionally been observed in patients treated with benzbromarone [5–9,11]. Benzbromarone and benzarone have similar structures to amiodarone, which causes mitochondrial toxicity and liver injury [10]. Liver injury induced by amiodarone causes hepatic steatosis and benzbromarone aggravates hepatic steatosis in obese patients [13]. Periodic liver function tests should be performed more frequently in patients with benzbromarone administration. We discuss the hepatotoxicity of benzbromarone and its future measures

Case Report

Findings

Conclusions