Fatal fulminant hepatitis associated with bromfenac use

OBJECTIVE: To report a case of fulminant hepatic failure associated with th e use of bromfenac, a new analog of the phenyl acetate class of nonsteroida l antiinflammatory drugs. CASE SUMMARY: A 60-year-old white woman with liver failure who had no known history of chronic liver disease was transferred to the liver transplant u nit for evaluation. For three months preceding her illness, the patient was treated with bromfenac 25 mg po qid for arthritic pain, Prior to the initi ation of bromfenac, her liver function test results were normal. Etiologic evaluation at presentation was unremarkable. The patient's condition contin ued to deteriorate, with the development of hepatic encephalopathy and wors ening Liver function test results while awaiting liver transplantation. Pro gressive hepatic and renal dysfunction along with respiratory decompensatio n ensued, and the patient died 48 days after initial presentation. CONCLUSION: Fulminant hepatic failure associated with the prolonged use of bromfenac appears to be an idiosyncratic response consistent with experienc e with other agents of its class. This case along with other cases of serio us hepatotoxicity associated with the use of this agent ultimately resulted in bromfenac's removal from the market.