Case Report
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World J Gastroenterol. Nov 28, 2011; 17(44): 4928-4931
Published online Nov 28, 2011. doi: 10.3748/wjg.v17.i44.4928
Acute liver failure caused by drug-induced hypersensitivity syndrome associated with hyperferritinemia
Masayuki Miyazaki, Masatake Tanaka, Akihiro Ueda, Tsuyoshi Yoshimoto, Masaki Kato, Makoto Nakamuta, Kazuhiro Kotoh, Ryoichi Takayanagi
Masayuki Miyazaki, Masatake Tanaka, Akihiro Ueda, Masaki Kato, Ryoichi Takayanagi, Kazuhiko Kotoh, Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 812-8582 Fukuoka, Japan
Tsuyoshi Yoshimoto, Makoto Nakamuta, Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, 812-8582 Fukuoka, Japan
Author contributions: Miyazaki M wrote the paper; Tanaka M, Ueda A, Yoshimoto T and Nakamuta M managed medical treatment of this case; Kato M and Kotoh K analyzed the data; Takayanagi R supervised the paper.
Correspondence to: Masayuki Miyazaki, MD, Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Telephone: +81-92-6425282 Fax: +81-92-6425287
Received: April 9, 2011
Revised: August 1, 2011
Accepted: August 15, 2011
Published online: November 28, 2011

Drug-induced hypersensitivity syndrome (DIHS) is a severe reaction usually characterized by fever, rash, and multiorgan failure, occurring 2-6 wk after drug introduction. It is an immune-mediated reaction involving macrophage and T-lymphocyte activation and cytokine release. A 54-year-old woman was diagnosed with rheumatic arthritis and initiated salazosulfapyridine by mouth. About 10 d later, she had a high fever, skin rash and liver dysfunction. She was admitted to hospital and diagnosed with a drug eruption. She was treated with oral prednisolone 30 mg/d; however, she developed high fever again and her blood tests showed acute liver failure and cytopenia associated with hyperferritinemia. She was diagnosed with acute liver failure and hemophagocytosis caused by DIHS. She was transferred to the Department of Medicine and Bioregulatory Science, Kyushu University, where she was treated with arterial steroid injection therapy. Following this treatment, her liver function improved and serum ferritin immediately decreased. We hypothesized that an immune-mediated reaction in DIHS may have generated over-activation of macrophages and T-lymphocytes, followed by a cytokine storm that affected various organs. The measurement of serum ferritin might be a useful marker of the severity of DIHS.

Keywords: Acute liver failure, Drug-induced hypersensitivity syndrome, Ferritin, Human herpes virus 6, Macrophage