J Korean Med Sci.  2008 Oct;23(5):903-905. 10.3346/jkms.2008.23.5.903.

Acute Drug-Induced Hepatitis Caused by Albendazole

• Choi GY
• Yang HW
• Cho SH
• Kang DW
• Go H
• Lee WC
• Lee YJ
• Jung SH
• Kim AN
• Cha SW

• KMID: 1783081
• DOI: http://doi.org/10.3346/jkms.2008.23.5.903

Abstract

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.

Keyword

Hepatitis, Toxic; Albendazole; Parasitex, Drug-induced

MeSH Terms

Albendazole/*adverse effects
Antiprotozoal Agents/*adverse effects
Eosinophils/metabolism
Glucose/metabolism
Hepatitis, Toxic/*diagnosis
Humans
Liver/drug effects
Liver Function Tests
Male
Middle Aged
Necrosis

Figure

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  Fig. 1 There are periportal steatosis and periportal necrosis (H&E stain, ×10).

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  Fig. 2 There are lymphocytic and few eosinophilic infiltration within tubular parenchyma of the portal tract (H&E stain, ×10).

Reference

1. Albendazole. 2000. MICROMEDEX;Available at: http://www.micromedex.com .

2. Kwak SJ, Oh HY, Yeo MA, Park SH, Kim JS, Lee JS, Kim HG. Fluoxetine-induced acute toxic hepatitis. Korean J Hepatol. 2000. 6:236–240.

3. Chae HB. Clinical features and diagnosis of drug-induced liver injury. Korean J Hepatol. 2004. 10:7–18.

4. Son HS, Kim GS, Lee SW, Kang SB, Back JT, Nam SW, Lee DS, Ahn BM. Toxic hepatitis associated with carp juice ingestion. Korean J Hepatol. 2006. 12:103–106.

5. Albenza® (albendazole) Tablets. Prescribing Information. 2007. Glaxo-SmithKline.

6. Seo JC, Jeon WJ, Park SS, Kim SH, Lee KM, Chae HB, Park SM, Youn SJ. Clinical experience of 48 acute toxic hepatitis patients. Korean J Hepatol. 2006. 12:74–81.

7. Benichou C. Criteria of drug-induced liver disorders. Report of an international consensus meeting. J Hepatol. 1990. 11:272–276.

8. Danan G, Benichou C. Causality assessment of adverse reactions to drugs--I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol. 1993. 46:1323–1330.

9. Morris DL, Smith PG. Albendazole in hydatid disease-hepatocellular toxicity. Trans R Soc Trop Med Hyg. 1987. 81:343–344.

10. Jagota SC. Jaundice due to albendazole. Indian J Gastroenterol. 1989. 8:58.

11. Choudhuri G, Prasad RN. Jaundice due to albendazole. Indian J Gastroenterol. 1988. 7:245–246.

12. Ahn BM. Acute toxic hepatitis: RUCAM application to drug-induced liver injury and its limitations. Korean J Hepatol. 2006. 12:1–4.

13. Lee WM. Drug-induced Hepatotoxicity. N Engl J Med. 1995. 333:1118–1127.