Abstract
We experienced a case of chronic renal failure with drug-induced liver injury, and recombinant human erythropoietin (rHuEPO) was considered to be the pathogenic agent.
The patient was a 72-year-old female who had a 15 year history of diabetes mellitus. On December 1994, this patient was admitted to our hospital because uremia due to diabetic nephropathy had developed. Normal liverfunction was found by clinical test on admission, and allergic diathesis or a history of the blood transfusion were not detected. On February 1, 1995, hemodialysis was initiated due to a gradual deterioration of renal function and a reduction in urinary output in spite of hospitalization. When 1, 500 units of epoetin alfa (Espo®) per hemodialysis was administered to this patient for the correction of renal anemia, she complained of fever and general fatigue, and developed leukocytosis and liver dysfunction (T-Bil; 2.0mg/dl, GOT; 560U, GPT; 637U, ALP; 11.8U, LDH; 1, 550U) on February 6. After the cessation of all medication abnormal liver function returned to normal.
After the re-administration of epoetin alfa abnormal liver function was found again, and treatment with epoetin alfa was stopped immediately. Subsequently, liver function was normalized, and symptoms disappeared. Both the lymphocyte stimulation test and an assay for anti-erythropoietin antibodies were negative. Since the maintenance of hematocrit level without rHuEPO was difficult in this patient irrespective of blood transfusion, epoetin beta (Epogin®) was administered to this patient. The effect of epoetin beta was sufficient without any adverse effects.
These results indicate that epoetin alfa was the etiological drug. Though the incidence of adverse effect of rHuEPO is low, we should pay attention to the possibility of drug-induced liver injury.
