Title:Unmasking of Metamizole-induced Liver Injury by Simult aneous
Development of Characteristic Agranulocytosis
Volume: 18
Issue: 3
Author(s): Mathias Lutz*, Inga Grünewald, Frank Lenze, Hauke Heinzow, Hansjörg Ullerich, Iyad Kabar, Hartmut H. Schmidt and Phil-Robin Tepasse
Affiliation:
- Department of Medicine A, Hematology and Oncology, University Hospital of Münster; Albert-Schweitzer-Campus 1,
D-48149 Münster, Germany
- Department of Medicine II, Hematology and Oncology, University Hospital of Augsburg;
Stenglinstr. 2, D-86156 Augsburg, Germany
Keywords:
Metamizole, dipyrone, liver, drug-induced liver injury, drug-induced hepatitis, agranulocytosis.
Abstract:
Background: Metamizole is one of the most used analgesic, antipyretic, and spasmolytic
agents in many countries worldwide. While metamizole-induced agranulocytosis is an, albeit
seldom, well-known adverse event, metamizole-associated drug-induced liver injury has been reported
rarely in the literature and hence often remains unconsidered. Here, we present a unique
case where metamizole-induced hepatotoxicity got unmasked by the simultaneous development of
characteristic agranulocytosis.
Case Report: A 22-year-old woman without known conditions presented with a new onset of fever,
jaundice, and maculopapular rash and explicitly denied intake of any new substances. Laboratory
tests showed liver injury, granulopenia, and positive anti-nuclear and anti-mitochondrial
(AMA-M2) antibodies. Liver biopsy revealed a histological pattern characteristic of drug-induced
liver injury and bone marrow biopsy, the classical picture of metamizole-induced agranulocytosis.
Indeed the in-depth interview of the patient unveiled metamizole consumption over the last two
months. Therefore, we could diagnose metamizole-induced hepato- and myelotoxicity. Accordingly,
steroid therapy led to normalization of liver parameters and stimulation with granulocyte colony-
stimulating factor to leukocyte recovery.
Conclusion: This case report is intended to increase the awareness of metamizole-associated druginduced
liver injury which should always be kept in mind due to its occasionally life-threatening
course. Diagnosis can be difficult particularly if anamnesis and written records are without hints
for prior metamizole intake.
