Daclatasvir and Asunaprevir Combination Therapy-induced Hepatitis and Cholecystitis with Coagulation Disorder due to Hypersensitivity Reactions

Yuichi Miyashima; Yuichi Honma; Koichiro Miyagawa; Shinji Oe; Michio Senju; Michihiko Shibata; Masaaki Hiura; Shintaro Abe; Masaru Harada

doi:10.2169/internalmedicine.55.7347

CASE REPORTS

Daclatasvir and Asunaprevir Combination Therapy-induced Hepatitis and Cholecystitis with Coagulation Disorder due to Hypersensitivity Reactions

Yuichi Miyashima, Yuichi Honma, Koichiro Miyagawa, Shinji Oe, Michio Senju, Michihiko Shibata, Masaaki Hiura, Shintaro Abe, Masaru Harada

Author information

Yuichi Miyashima
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Yuichi Honma
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Koichiro Miyagawa
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Shinji Oe
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Michio Senju
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Michihiko Shibata
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Masaaki Hiura
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Shintaro Abe
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
Masaru Harada
Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Japan

Keywords: asunaprevir, chronic hepatitis C, complement deficiency, daclatasvir, disseminated intravascular coagulation

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 24 Pages 3595-3601

DOI https://doi.org/10.2169/internalmedicine.55.7347

Details

Abstract

A 70-year-old woman with chronic hepatitis C was admitted to our hospital due to liver injury, cholecystitis, and disseminated intravascular coagulation with a fever and skin rash. She had been on a combination regimen of daclatasvir and asunaprevir for 2 weeks of a 24-week regimen. Because of the symptoms, laboratory findings, results of a drug-induced lymphocyte stimulation test, and pathological findings of liver biopsy, we diagnosed her with drug-induced liver injury. Although daclatasvir and asunaprevir combination therapy is generally well-tolerated, some serious adverse effects have been reported. Our findings indicate that immunoallergic mechanisms were associated with daclatasvir and asunaprevir-induced liver injury.

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