Liver injury and exfoliative dermatitis caused by nifuratel

A 34-year-old female patient received oral nifuratel 0.4 g thrice daily and nifuratel-nystatin vaginal suppositories 0.2 g twice daily. After 1 day of treatment, the patient developed scattered rashes and desquamation on her whole body, diffused hemorrhagic rashes on her lower extremities. Nifuratel was stopped. Twenty-one days later, the patient developed abdominal pain, dark urine, fatigue, and yellowish skin. Rashes and desquamation were not improved. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, total bilirubin (TBil), direct bilirubin, and prothrombin activity (PTA) were 945 U/L, 1 027 U/L, 226 U/L, 290.1 μmol/L, 225.9 μmol/L, and 53%, respectively. Hepatitis A, B, C, D, E virus infection markers were negative and the patient had no history of abnormal liver function. It was considered that the liver injury and exfoliative dermatitis were caused by nifuratel. Anti-allergic and hepato-protective treatments were given. After 3 months of treatments, the rashes basically subsided. The levels of ALT, AST, TBil, and PTA were 85 U/L, 47 U/L, 51.4 μmol/L, and 83%, respectively. At 75 days of follow-up, the patient's results of liver function tests returned to normal, the rashes disappeared completely, and the levels of ALT, AST, TBil were 20 U/L, 26 U/L, and 5.4 μmol/L, respectively. Key words: Nifuratel; Drug-induced liver injury; Dermatitis, exfoliative