A Rare Case of Drug Induced Liver Injury Secondary to Empagliflozin
DOI:
https://doi.org/10.24950/rspmi.cc.131.4.2021Keywords:
Chemical and Drug Induced Liver Injury; Sodium-Glucose Transporter 2 Inhibitors/adverse effectsAbstract
Drug induced liver injury (DILI) is a condition with a wide clinical spectrum. The diagnosis represents a challenge not only due to the large number of known hepatotoxic products but especially when the substance involved is not known to induce liver damage. Empagliflozin is linked to several adverse effects but has not been convincingly associated to DILI. We report a case of a 70-year-old type 2 diabetic woman that presented with gastrointestinal symptoms 1 month after empagliflozin introduction. Elevated hepatic enzymes were found and despite ultrasound evidence of vesicular microlithiasis, no biliary obstruction was confirmed. Other causes of liver injury were excluded and the diagnosis of DILI secondary to empagliflozin was made after liver biopsy. Complete clinical and laboratorial resolution was verified after empagliflozin withdrawal. Only two cases of DILI were reported since empagliflozin licensure which makes this case more interesting, alerting clinicians to an early diagnosis and appropriate treatment.
Downloads
References
Stirnimann G, Kessebohm K, Lauterburg B. Liver injury caused by drugs: an update. Swiss Med Wkly. 2010;140:w13080. doi: 10.4414/smw.2010.13080.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Sodium Glucose Cotransporter-2 (SGLT-2) Inhibitors. [Updated 2018 Dec 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548289/
Andrade RJ, Aithal G, Björnsson E, Kaplowitz N, Kullak-Ublick GA, Larrey D, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury. J Hepatol. 2019;70:1222-61. doi: 10.1016/j.jhep.2019.02.014.
Lucena MI, Sanabria J, García-Cortes M, Stephens C, Andrade RJ. Drug-induced liver injury in older people. Lancet Gastroenterol Hepatol. 2020;5:862-74. doi: 10.1016/S2468-1253(20)30006-6.
Culver EL, Watkins J, Westbrook RH. Granulomas of the liver. Clin Liver Dis. 2016;7:92-6. doi: 10.1002/cld.544.
Kleiner DE. Liver histology in the diagnosis and prognosis of drug‐induced liver injury. Clin Liver Dis. 2014;4:12-6.
Calado J, Silva Nunes J. Empagliflozina: Uma Nova Arma Farmacológica na Terapêutica da Diabetes Tipo 2. Rev Port Diabetes. 2015; 10: 118-26.
Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, et al. Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology. 2015;148:1340-52.
Storgaard H, Gluud LL, Bennett C, Grøndahl MF, Christensen MB, Knop FK, et al. Benefits and Harms of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. PLoS One. 2016;11:e0166125.
Häring HU, Merker L, Seewaldt-Becker E, Weimer M, Meinicke T, Woerle HJ, et al. Empagliflozin as add-on to metformin plus sulfonylurea in patients with type 2 diabetes: a 24-week, randomized, double-blind, placebo-controlled trial. Diabetes Care. 2013;36:3396-404.
Kuchay MS, Krishan S, Mishra SK, Farooqui KJ, Singh MK, Wasir JS, et al. Effect of empagliflozin on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease: A Randomized Controlled Trial (E-LIFT Trial). Diabetes Care. 2018;41:1801-08. doi: 10.2337/dc18-0165.
Ridderstråle M, Andersen KR, Zeller C, Kim G, Woerle HJ, Broedl UC. Comparison of empagliflozin and glimepiride as add-on to metformin in patients with type 2 diabetes: a 104-week randomised, active-controlled, double-blind, phase 3 trial. Lancet Diabetes Endocrinol. 2014;2:691-700.
Ptaszynska A, Johnsson KM, Parikh SJ, de Bruin TW, Apanovitch AM, List JF. Safety profile of dapagliflozin for type 2 diabetes: pooled analysis of clinical studies for overall safety and rare events. Drug Saf. 2014;37:815-29. doi: 10.1007/s40264-014-0213-4.
Levine JA, Lo AA, Wallia A, Rogers M, VanWagner LB. Dapagliflozin-induced acute-on-chronic liver injury. ACG Case Rep J. 2016;3:e169. doi: 10.14309/crj.2016.142.
Famularo G, Sajeva MR, Marino G, Granato C. Acute hepatitis caused by empagliflozin in a nonalcoholic fatty liver disease patient. Ann Pharmacother. 2017;51:1142-3.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
