Four Cases of Severe Hepatotoxicity Associated With Pemoline: Possible Autoimmune Pathogenesis
| Autor: | Michael R. Narkewicz, Susan F. Dellert, Joel R. Rosh, Audrey Birnbaum, Gene L. Whitington |
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| Rok vydání: | 1998 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Anti-nuclear antibody medicine.medical_treatment Pemoline Jaundice Liver transplantation Gastroenterology Organomegaly Autoimmune Diseases Fulminant hepatic failure Internal medicine medicine Humans Child Hepatic encephalopathy business.industry Hepatitis A medicine.disease Attention Deficit Disorder with Hyperactivity Hepatic Encephalopathy Pediatrics Perinatology and Child Health Immunology Central Nervous System Stimulants Female Chemical and Drug Induced Liver Injury medicine.symptom business medicine.drug |
| Zdroj: | Pediatrics. 101:921-923 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.101.5.921 |
| Popis: | Pemoline (Cylert) is a central nervous system stimulant first introduced into clinical trials in the 1970s. Currently, it is most commonly used to treat children with attention deficit disorder (ADD).1,2 There have been scattered reports of hepatotoxicity with pemoline usually involving transient elevation of liver chemistries.3-6 Overt liver failure has been rarely reported.7-10 During the last 3 years we encountered four cases of marked liver dysfunction in children on pemoline. Two of these progressed to fulminant hepatic failure requiring liver transplantation. In those cases where autoantibodies were measured, there was evidence for autoimmune activation (see Tables1 and 2). View this table: Table 1. Pemoline Treatment and Autoimmune Findings View this table: Table 2. Presentation and Outcome ### Case 1 This patient was an adopted 14-year-old girl with ADD unresponsive to methylphenidate. Pemoline, 37.5 mg per day, was instituted with some improvement in school performance. Liver chemistries were not routinely monitored. Six months later, jaundice and fatigue developed. Physical examination was notable for jaundice and no organomegaly. Liver transaminases were in the 1000 IU/L range with a total bilirubin of 8 mg/dL with a direct fraction of 6 mg/dL. The serum albumin level was normal but the prothrombin time was elevated to 17 seconds (normal |
| Databáze: | OpenAIRE |
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