Acute Liver Failure Caused by Paracetamol Toxicity: a Case Report

Acute liver failure (ALF) is the clinical manifestation of sudden and severe hepatic injury. It is a rare disorder, with an incidence between one and six cases per million people every year in the developed world, and it has a high mortality rate. There are many definitions of ALF, but it is mainly characterised by the presence of encephalopathy during the course of fulminant hepatitis in a patient without previously known hepatopathy. The causes of ALF are many and vary in reason and geographic region, but the main causes are viral hepatitis (in particular, hepatitis B virus and hepatitis A virus) and medication overdose, in particular, paracetamol, but it can also occur with statins, non-steroidal anti-inflammatories, antibiotics (nitrofurantoin and ketoconazole), anti-epileptics (phenytoin and valproate), anti-tuberculosis drugs, particularly isoniazid, and other drugs such as propylthiouracil and disulfiram. In 13-17% of patients, ALF is attributed to an idiosyncratic drug reaction. Rare causes are hyperthermic injury from heat shock or after a protracted seizure, toxic insults (poisoning with toxic mushroom species such as Amanita spp.), Wilson’s disease, autoimmune hepatitis, ischaemic injury as a result of systemic hypotension with sepsis or cardiac failure, Budd-Chiari syndrome, malignant infiltration of the liver, or pregnancy-related disActa Medica Mediterranea, 2017, 33: 55