TITLE:
Carbimazole Drug-Induced Hepatitis during Treatment of Graves’ Disease: About Four Cases at Dakar Teaching Hospital
AUTHORS:
Abdoulaye Leye, Michel Assane Ndour, Nafy Ndiaye Sarr, Ngoné Diaba Diack, Yakham Mohamed Leye, Dominique Emmanuel Faye
KEYWORDS:
Drug-Induced Hepatitis, Carbimazole, Graves’ Disease
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.7 No.4,
October
18,
2017
ABSTRACT: Introduction: Mostly reported common side effects of carbimazole are cutaneous
allergies and severe agranulocytosis. However, hepatotoxicity is rarely
described. Thus, we report four observations of carbimazole drug-induced
hepatitis during the treatment of Graves’ disease, which imputability is likely and probably
an immuno-allergic mechanism. Observations: They were
four women whose average age was 43 years, with extreme ages of 32 and 54.
Patients were monitored and treated with carbimazole in doses contained between
40 mg and 60 mg per day. Clinical manifestations of liver injury were mainly dominated
by cholestatic jaundice, found in 100% of our patients. A painful sensitivity
of the right hypochondrium was concomitant with jaundice for two patients. The
jaundice time to onset after the beginning of treatment with carbimazole varies
between 1 month and 6 months. They all had acute hepatitis. The biological
assays used to determine the type of liver injury showed, in all cases, a
mixed, cholestatic and cytolytic hepatitis. Therapeutically, in all patients,
carbimazole was stopped as soon as the suspicion of its incrimination in the
occurrence of liver damage was set up. They all had a substitution of
carbimazole with benzylthiouracil. Evolution was favorable for all patients,
after therapeutic substitution. It was marked by disappearance of jaundice and normalization of the
liver biological parameters within a maximum
delay of two months after stopping carbimazole use. Conclusion: Treatment with synthetic antithyroid drugs, particularly
carbimazole that is most widely used in our regions, requires clinical
and biological monitoring. This surveillance, which is often difficult in
Africa because of the limited economic resources, can lead to the occurrence of
side effects such as potentially serious drug-induced hepatitis, but which has
been favorable in our observations.