Montelukast kullanımına bağlı akut fulminan seyirli hepatit vakası

Abstract

Drug-induced liver injury is commonly encountered in general practice and a potential complication of many medications. Hepatotoxicity associated with montelukast-induced liver injury including elevated liver tests, hepatitis and fulminant liver failure has been described with rare case reports. We present the case of a 42-year-old woman with montelukast-induced fulminant liver failure. A 42-year-old woman had been taking salbutamol inhaler and salmeterol + fluticasone inhaler for five years and montelukast sodium for resistant asthma for three months, and was referred to our gastroenterology clinic with complaints of progressive abdominal pain, jaundice, and unconsciousness. We considered acute hepatic failure based on the laboratory and clinical findings. The patient was evaluated for other possible causes of hepatocellular damage (infectious, metabolic, autoimmune diseases, drugs, etc.). Liver biopsy was performed and revealed acute hepatitis with bridging necrosis, and there was no cirrhosis finding. Montelukast treatment was stopped, and supportive treatment was started for hepatocellular failure. Fifteen days after stopping montelukast, the liver function tests began to improve and symptoms of hepatic failure also diminished. She presented for follow-up 50 days after stopping montelukast, and liver function tests were confirmed as almost normal. We advise that periodic screening of liver function tests should be performed in patients taking montelukast. If any abnormality is detected, these patients should be referred to a center experienced in the treatment and follow-up of these patients.