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• W2912584013 abstract "A 77-year-old woman with a history of Waldentroms macroglobulinemia on ibrutinib (started 2 months before admission) was sent in from clinic for new jaundice. The patient had nausea and burning epigastric pain two weeks prior to admission, and when she was seen in clinic her ibrutinib was held. The jaundice started two days before presentation and was associated with fatigue and malaise. Patient denied any fevers, vomiting, diarrhea, constipation, or changes in stool/urine color. She denied taking any over the counter medications. On presentation, she was afebrile with normal vital signs. She had a normal CBC and BMP but LFTs were markedly elevated (AST 1300, ALT 1747, ALP 200, total bilirubin 10.4, direct bilirubin 8.5). Her INR was 1.6. She was alert and oriented, with no signs of encephalopathy. ANA was weakly positive and anti-smooth muscle antibody was negative. CT of the abdomen and pelvis was normal. Liver biopsy was significant for mixed inflammatory infiltrates of portal tracts with plasma cells, eosinophils and neutrophils. There was lobular disarray secondary to inflammation, hepatocellular necrosis and ballooning. The findings on liver biopsy were consistent with drug-induced hepatitis without signs of fibrosis. The patient had normal LFTs before initiation of ibrutnib and had a negative autoimmune and infectious workup. The time frame of symptoms and liver injury in association with ibrutinib initiation along with the liver biopsy results are highly suggestive of ibrutinib induced liver injury. Drug Induced Liver Injury (DILI), is an important cause of drug withdrawal or deregistration. In order to make a diagnosis of DILI, other potential causes of liver injury such as viral and autoimmune need to be ruled out. The drug thought to be contributing to DILI should precede the hepatic injury, and discontinuation of the drug should lead to improvement in liver function tests. Ibrutinib, a Bruton tyrosine kinase inhibitor, is used in the treatment of certain leukemias and lymphomas. Per the NIH liver toxicity website, acute liver toxicity or failure secondary to ibrutinib have not been reported. The most common side effects associated with this medication includes vomiting, diarrhea, arthralgias, myalgias and cytopenias. Aside from this case report, there has only been one other case report of ibrutinib causing DILI. This medication should be considered a potential cause of DILI, and the NIH should consider adding this information to the website." @default.
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• W2912584013 date "2017-10-01" @default.
• W2912584013 modified "2023-09-26" @default.
• W2912584013 title "Ibrutinib-induced Liver Injury" @default.
• W2912584013 doi "https://doi.org/10.14309/00000434-201710001-02123" @default.
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