[Asymptomatic acute cytolytic hepatitis due to fluindione and associated with resistance to treatment: a case report and review of the literature]

Abstract

The authors report a case of asymptomatic acute cytolytic hepatitis due to fluindione (Previscan) associated with relative and selective resistance to this drug prescribed as a relay of heparin therapy for deep venous thrombosis following immobilisation of a sprained ankle in a 22 year-old patient. The main complications of oral anticoagulants are bleeding. Very severe immuno-allergic complications, especially hepatic, have been described with phenindione therapy. A review of the literature revealed a very low incidence of fluindione-induced hepatitis (7 cases), only two of which were fully documented since the commercialization of this molecule in 1971. No fatalities were reported: resistance to the treatment seemed to be associated. The exact mechanism (toxicity or immuno-allergy) has not been determined although the fact that fluindione is one of the indanedione family is in favour of the latter hypothesis.