BMJ Case Reports 2018; doi:10.1136/bcr-2017-223329
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Flupirtine drug-induced liver injury in a patient developing acute liver failure

  1. Luis Tomé1,2
  1. 1Department of Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  2. 2Faculty of Medicine, Coimbra University, Coimbra, Portugal
  1. Correspondence to Dr David Noiva Perdigoto, davidperdigoto{at}, dperdigoto{at}
  • Accepted 20 February 2018
  • Published 9 March 2018


A patient is admitted with complaints of recent onset nausea, discomfort, jaundice and blood tests that reveal severe hepatitis. At the time, she had been taking medication with Hypericum perforatum (St John’s wort) for 6 months, and 6 weeks before this event, she took flupirtine maleate. A few days after being admitted, she developed encephalopathy progressing to acute liver failure (ALF) requiring unsuccessful liver transplantation. The patient was ultimately diagnosed with drug-induced liver injury (DILI). In this context, while H. perforatum could interfere with other medication or trigger DILI itself, flupirtine appears to have triggered the DILI, given its liver toxicity capacity. DILI is one of the major ALF causes and can jeopardise patient’s life. Accordingly, all efforts to reduce medication potentially hazardous to the liver are recommended.


  • Contributors DNP: Data gathering, manuscript preparation and drafting. PA and MF: critical revision of the manuscript. LT: manuscript final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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