Fatal hepatitis and renal failure during treatment with nimesulide

A healthy 70-year-old woman who took nimesulide for 5 days, presented 2 wee ks later with jaundice for which no other cause was found. Laboratory evide nce of coaguropathy, hypoalbuminaemia and hypoglycaemia were present on adm ission, and liver biopsy showed massive necrosis of hepatocytes and severe inflammatory infiltrate. Despite supportive and corticosteroid treatment, h er jaundice deepened and progressive acute renal failure developed, charact erized by a 'prerenal' profile changing into irreversible acute tubular nec rosis pattern, coma, occult Gram-negative sepsis and death. Although rare, nimesulide-associated hepatotoxicity and nephrotoxicity may occur and shoul d be recognized as early as possible, to ensure immediate drug withdrawal a nd treatment.