Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Friday, 05 / 14 / 2021

Articles

Abstract

LETTER TO THE EDITOR

Favipiravir-induced Liver Injury in Patients with Coronavirus Disease 2019

Pramod Kumar1,* , Anand Kulkarni1 , Mithun Sharma1 , Padaki Nagaraja Rao1 and  Duvvuru Nageshwar Reddy2

1  Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
2  Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
*Correspondence to: Pramod Kumar, Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology Hospitals, Survey No 136, Mindspace Rd, Gachibowli, Hyderabad, Telangana 500032, India. ORCID:  https://orcid.org/0000-0002-1073-6295. Tel: +91-98-1493-3544, E-mail:  This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(2):276-278 DOI: 10.14218/JCTH.2021.00011
Received: January 4, 2021 Accepted: March 23, 2021 Published online: April 15, 2021

Favipiravir, an antiviral, was given restricted emergency use approval to treat coronavirus disease 2019 (COVID-19) in many countries. While the clinical efficacy of favipiravir in COVID-19 remains uncertain, the approval was based on findings from in vitro studies and a clinical trial.1 Limited data from studies of the Ebola virus and influenza disease showed a favorable safety profile.2 Herein, we provide the first report of drug-induced liver injury (DILI) due to favipiravir in patients treated for COVID-19.

The first patient is a 70-year-old female who presented with 4 days of abdominal pain and jaundice. Historically, she received tab Favipiravir for mild COVID-19 illness for 2 weeks. She denied having taken any other medications or herbal supplements, or alcohol intake. She was icteric, and laboratory evaluation revealed a cholestatic liver chemistry pattern. Hepatitis A/B/C/E serologies, autoimmune markers, ceruloplasmin, and serologies for Epstein-Barr/Herpes simplex/cytomegalovirus, hepatic Doppler ultrasound were all negative/normal. A percutaneous liver biopsy showed moderate hepatocellular cholestasis with bilirubinostasis and mild inflammation comprised of lymphocytes with few eosinophils in the portal tracts. The patient was treated with ursodeoxycholic acid (15 mg/kg), and liver biochemistry normalized after 10 weeks. In the absence of other etiologies, bland cholestasis on liver biopsy, and Roussel Uclaf causality assessment method (RUCAM) score of 7, consistent with probable DILI, the diagnosis of favipiravir-induced acute cholestatic jaundice was made.

Journal of Clinical and Translational Hepatology 2021 vol. 9, 276-278  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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