A Case Report of Ivermectin-Induced Liver Failure
American Journal of Gastroenterology
; 117(10 Supplement 2):S1898, 2022.
Article
in English
| EMBASE | ID: covidwho-2326306
ABSTRACT
Introduction:
Ivermectin is an antiparasitic medication that is primarily metabolized by the liver. During the COVID-19 pandemic, researchers demonstrated that Ivermectin successfully inhibited the replication of SARS-COV-2 in vivo, but current research has failed to demonstrate clinical benefit for treatment of COVID-19. Despite this, misinformation campaigns have misled patients to ingest Ivermectin at concentrations meant for domestic animals. Here, we present a case of acute liver failure secondary to the use of Ivermectin. Case Description/Methods:
A 61-year-old man with medical history of ischemic cardiomyopathy with last echocardiogram showing ejection fraction at 21%, atrial fibrillation on warfarin for oral anticoagulation, and previously treated Hepatitis C presented with generalized weakness and yellowish discoloration of the skin worsening over the last two weeks. The patient denied significant alcohol use, acetaminophen use, or illicit drugs. He admitted to injecting himself with two doses of weight-based horse ivermectin, for COVID prophylaxis, two weeks prior to his presentation. Physical exam was pertinent for scleral icterus and hepatomegaly with no abdominal tenderness. Initial labs revealed elevated liver chemistries in a mixed pattern (Figure 1). Acute hepatitis panel, HSV, and CMV were negative. Hepatitis C antibodies were positive, but the patient was in sustained virologic response. Full workup for chronic liver disease was unremarkable. Ultrasound revealed hepatosplenomegaly with patent portal and hepatic vasculature. Subsequently, the patient developed hepatic encephalopathy along with his coagulopathy, raising concern for acute hepatic failure. The patient was transferred to the ICU and started on NAcetylcysteine, rifaximin, and supportive care. The patient recovered well and fortunately did not require liver transplant. Discussion(s) While the FDA recommends against the use of Ivermectin for COVID-19, many continue to inappropriately consume it. Ivermectin-induced liver failure is a rare but deadly side effect. Given our patient's rapid onset of symptoms post-self injection of Ivermectin, his liver injury was presumed to be related to Ivermectin. The drug interaction between Ivermectin and warfarin had worsened the patients coagulopathy. Physicians should be aware of the ways Ivermectin overdose may clinically present to avoid delayed treatment. This case demonstrates the detriments of perpetuation of medical misinformation to care.
abdominal tenderness; acute hepatitis; acute liver failure; adult; adverse drug reaction; alcohol consumption; anticoagulation; asthenia; atrial fibrillation; blood clotting disorder; case report; chronic liver disease; clinical article; conference abstract; coronavirus disease 2019; domestic animal; drug overdose; drug therapy; echocardiography; heart ejection fraction; hepatic encephalopathy; hepatitis C; hepatomegaly; hepatosplenomegaly; horse; human; in vivo study; ischemic cardiomyopathy; jaundice; liver circulation; liver failure; liver graft; liver injury; male; medical history; middle aged; misinformation; nonhuman; pandemic; patent; physical examination; physician; prophylaxis; sclera; self injection; Severe acute respiratory syndrome coronavirus 2; side effect; skin discoloration; surgery; sustained virologic response; treatment failure; hepatitis C antibody; illicit drug; ivermectin; paracetamol; rifaximin; warfarin
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Case report
/
Prognostic study
Topics:
Vaccines
Language:
English
Journal:
American Journal of Gastroenterology
Year:
2022
Document Type:
Article
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