Acetaminophen Caused Transfusion Dependent Children Repeated Hepatitis

Abstract

Acetaminophen, one of the safest and most frequently used analgesic/antipyretic drug, demonstrates lower toxicity in children than adults. A 3-year old girl was diagnosed with hereditary spherocytosis at 4 months of age, and history of regular blood transfusions was reported several episodes of acute hepatitis following administration of acetaminophen ( 10 mg/kg/dose ) for prophylaxis of transfusion reaction.

There are two acute hepatitis episodes were occurred after acetaminophen ingestion. On both occasions, liver enzymes (upper than normal value 3.6-8.4 fold) reduced to 50% within 7 days, while jaundice resolved after 10 days of drug withdrawal. Thus, she was diagnosed with drug-induced hepatitis.

Abdominal sonography showed hepatomegaly and increased liver parenchyma. Histological examination (liver biopsy) revealed significant hepatocytic swelling, pericentral necrosis, evident intrahepatocytic and intra-cannalicular cholestasis, portal bile ductular proliferation, and mild mixed lymphocytic and eosinophilic infiltrations. Genetic tests using exome sequencing method showed that CYP2C19 c.681G>A, CYP2D6 c.1457C>G, CYP2D6 c.886T>C, and MAST4 c.7574dupG, thus further experimentation is needed to identify the acetaminophen-induced hepatotoxicity relationship.

Therapeutic doses of acetaminophen administered in patients with underlying hematologic diseases, may induce hepatotoxicity, which usually results from overdose. If children have the similar symptoms, non-steroidal anti-inflammatory drugs should be the better antipyretic.