Fulminant hepatic failure due to diclofenac treated successfully by orthotopic liver transplantation
A 62-year-old woman had received Arthrotec® (containing diclofenac and misoprostol) 50 mg three times per day for two months for treatment of a painful left heel. She subsequently developed fulminant hepatic failure for which viral and auto-immune etiologies were excluded. Other drugs or chemical exposures were also excluded. She developed five out of five poor prognostic criteria for nonparacetamol drug-induced fulminant hepatic failure and underwent successful orthotopic liver transplantation from which she made an excellent recovery. This is the first report of successful treatment of diclofenac-induced fulminant hepatic failure. Four similar cases reported previously in the literature have died without intervention by liver transplantation. Putative mechanisms for diclofenac toxicity are reviewed.