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Terziroli Beretta-Piccoli B, Mieli-Vergani G, Bertoli R, et al. Atovaquone/proguanil-induced autoimmune-like hepatitis. Hepatol Commun. 2017;1(4):293-298doi: 10.1002/hep4.1039.
Terziroli Beretta-Piccoli, B., Mieli-Vergani, G., Bertoli, R., Mazzucchelli, L., Nofziger, C., Paulmichl, M., & Vergani, D. (2017). Atovaquone/proguanil-induced autoimmune-like hepatitis. Hepatology communications, 1(4), 293-298. https://doi.org/10.1002/hep4.1039
Terziroli Beretta-Piccoli, Benedetta, et al. "Atovaquone/proguanil-induced autoimmune-like hepatitis." Hepatology communications vol. 1,4 (2017): 293-298. doi: https://doi.org/10.1002/hep4.1039
Terziroli Beretta-Piccoli B, Mieli-Vergani G, Bertoli R, Mazzucchelli L, Nofziger C, Paulmichl M, Vergani D. Atovaquone/proguanil-induced autoimmune-like hepatitis. Hepatol Commun. 2017 May 08;1(4):293-298. doi: 10.1002/hep4.1039. eCollection 2017 Jun. PMID: 29404460; PMCID: PMC5721398.
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Hepatol Commun. 2017 May 08;1(4):293-298. doi: 10.1002/hep4.1039. eCollection 2017 Jun.

Atovaquone/proguanil-induced autoimmune-like hepatitis.

Hepatology communications

Benedetta Terziroli Beretta-Piccoli, Giorgina Mieli-Vergani, Raffaela Bertoli, Luca Mazzucchelli, Charity Nofziger, Markus Paulmichl, Diego Vergani

Affiliations

  1. Epatocentro Ticino Lugano Switzerland.
  2. Paediatric Liver, GI and Nutrition Centre King's College Hospital London United Kingdom.
  3. Regional Pharmacovigilance Center, Division of Clinical Pharmacology and Toxicology Ente Ospedaliero Cantonale Lugano Switzerland.
  4. Istituto Cantonale di Patologia Locarno Switzerland.
  5. Institute of Pharmacology and Toxicology Paracelsus Medical University Salzburg Austria.
  6. Center for Health and Bioresources Austrian Institute of Technology Vienna Austria.
  7. Institute of Liver Studies King's College Hospital London United Kingdom.

PMID: 29404460 PMCID: PMC5721398 DOI: 10.1002/hep4.1039

Abstract

We report a novel association between the commonly used antimalarial medication atovaquone/proguanil and drug-induced autoimmune-like hepatitis. The patient developed severe liver disease fulfilling biochemical, immunologic, and histologic criteria for the diagnosis of autoimmune hepatitis after the inadvertent rechallenge with the offending drug, which had caused self-limited hepatitic symptoms a year previously. Over a period of 18 months, the patient underwent two follow-up liver biopsies showing progressive resolution of the liver inflammation and achieved complete biochemical and immunologic remission on steroids. This remission persisted for 20 months following treatment withdrawal.

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