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Thiabendazole-induced acute liver failure requiring transplantation and subsequent diagnosis of polyarteritis nodosa.

Clinical and experimental rheumatology (2012-07-26)
Matthieu Groh, Philippe Blanche, Yvon Calmus, Loïc Guillevin
ABSTRACT

Polyarteritis nodosa (PAN), a systemic necrotising vasculitis that affects medium- and small-sized arteries, has visceral involvement in 40-60% of the patients. According to the Five-Factor Score (FFS), it is associated with poor outcome. We describe a patient who underwent orthotopic liver transplantation (OLT) for severe ductopenia induced by thiabendazole that was empirically prescribed for chronic hypereosinophilia. Eleven years later, despite immunosuppressive treatment to prevent graft rejection, he developed mononeuritis multiplex; PAN was diagnosed. He also had severe recurrent ischaemic cholangitides because of post-OLT hepatic artery ligation to treat a postoperative severe haematemesis. His outcome was favourable after second OLT, under steroids, cyclophosphamide pulses and tacrolimus. In retrospect, his initial symptoms and hypereosinophilia were probably attributable to PAN.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Thiabendazole, ≥99%, powder
Supelco
Thiabendazole, PESTANAL®, analytical standard
Sigma-Aldrich
Thiabendazole, BioReagent, suitable for plant cell culture, powder
Supelco
Thiabendazole, Pharmaceutical Secondary Standard; Certified Reference Material
Tiabendazole, European Pharmacopoeia (EP) Reference Standard

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