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Jornal Português de Gastrenterologia

Print version ISSN 0872-8178

J Port Gastrenterol. vol.15 no.4 Lisboa Oct. 2008

 

Hepatotoxicidade por Nimesulide A propósito de um caso clínico

S. Rito Nobre, J.M. Romãozinho, M. Ferreira, P. Amaro, J.E. Pina Cabral, M. C. Leitão (1)

 

 

Resumo

Doente do sexo feminino, com 44 anos de idade, residenteem ambiente rural, com um quadro inicial de leucorreia e adenopatias inguinais, pelo que foi medicada com nimesulide. Dois dias depois desenvolveu sintomas constitucionais. Na admissão hospitalar apresentava icterícia, sufusão conjuntival e hiperémia orofaríngea. Laboratorialmente destacavam-se citopenia, citólise hepática marcada, colestase, insuficiência renal e elevação da proteína C reactiva. A investigação complementar revelou anticorpos antinucleares positivos, ligeiro aumento das imunoglobulinas M e E, e espessamento da parede vesicular. O teste de transformação linfoblástica para o nimesulide foi positivo. Registou-se melhoria clínica e laboratorial após a suspensão do fármaco. Os autores discutem as principais hipóteses diagnósticas, enfatizando os critérios definidores de hepatotoxicidade e a dificuldade inerente à comprovação deste diagnóstico.

 

 

Summary

A case of a forty-four years old rural female admitted due to vaginal discharge and inguinal lymphadenopathies is presented. She took nimesulide and, after two days, started with constitutional symptoms. At hospital admission she presented with jaundice, conjunctival suffusion and pharyngeal injection. Blood tests revealed cytopenia, marked hepatic citolysis, cholestasis, renal failure and reactive C protein elevation. Complementary studies showed positive antinuclear autoantibodies, mild elevation of immunoglobulins M and E, and a thickened gallbladder wall. Lymphocyte transformation test was positive for nimesulide. There was a clinical and laboratorial improvement after cessation of the drug. The authors discuss the main diagnostic hypotheses enfatizing definition criteria for hepatotoxicity and also the difficulty in establishing this diagnosis.

 

 

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Bibliografia

 

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(1)Serviço de Gastrenterologia dos Hospitais da Universidade de Coimbra

Correspondência:

Sónia Rito Nobre

Serviço de Gastrenterologia - Hospitais da Universidade de Coimbra

Avenida Bissaya Barreto e Praceta Mota Pinto

3000-075 Coimbra

Telefone: 239400483

Fax: 239701517

E-mail: soninobre@hotmail.com

 

Recebido para publicação: 27/08/2007

Aceite para publicação: 14/05/2008