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Fatal drug induced liver injury Introduction Hepatotoxicity to drugs poses a major challenge to clinicians because of the risk of fulminant hepatic failure and mortality in cases of serious liver injury. There are exceptional studies reporting fatalities associated with drug liver injury. The aim of this study was to assess the cases of fatal liver injury related to drugs notified to Pharmacovigilance center. Methods We performed a retrospective analysis of hepatotoxicity cases with fatal issue notified to the pharmacovigilance center between 1998 and 2010 and analysed according to Begaud’s method of imputation. We retained 18 cases of fatal liver injury induced by drugs. Results There were 11 males and 7 females. The median age of the patients was 49 years (ranged between 16 and 78). The types of liver injury were cytolysis in 11 patients, cholestasis in 4 patients and mixt in one case. Drug Imputation scores were highly probable (I3) in two cases (one case was associated with benzbromarone and the other with isoniazide), probable (I2) in 13 cases, and possible (I1) in 3 cases. In all cases more than one drug was suspected in the genesis of fatal liver injury. The most common drug types associated with fatalities were: antibacterial drugs (mainly isoniazide and rifampicine), anesthetic (halothane) and analgesics. Discussion Exceptional studies have assessed fatalities associated with drug induced liver injury. In a retrospective study, Björnsson had screened all reports of suspected hepatic adverse drug reactions with a fatal outcome received by the WHO Collaborating Centre for International Drug Monitoring in Uppsala Sweden from 1968 to 2003. Twenty-one drugs, associated with at least 50 fatalities, were analysed. The most common drug types found were analgesics, drugs against human immunodeficiency virus, anticonvulsants and antibacterial drugs. In our study, antibacterial drugs, anesthetics and analgesics were the most associated drugs. CONCLUSION The current study allowed the analysis of some features of fatal drug induced liver injury notified to pharmacovigilance center.
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