Fatal hepatotoxicity secondary to nimesulide

This report describes a 57-year-old fen-tale patient with chronic lumbago, who died from the sequelae of acute liver failure induced by nimesulide med ication. Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) which preferentially inhibits cyclo-oxygenase 2 and has been associated with a t otal of 13 reported cases of severe liver injury including our case. On the basis of the literature reports, the following features of nimesulide-asso ciated hepatotoxicity were identified: female sex (84% of cases), age (mean age 62 years), jaundice as a primary manifestation (90%) and the absence o f peripheral blood eosinophilia. The average duration of therapy of the pub lished cases was 62 days (range 7-180 days). Based on spontaneous reports t o the World Health Organization, nimesulide induces a high proportion of se vere adverse hepatic reactions compared with other NSAIDs registered in Swi tzerland. Hepatotoxicity thus represents an important risk factor of nimesu lide usage.