Liver Failure (Depakote) Medical Malpractice Lawsuit

[bbc586]

Link to case here: Liver Failure [Medication-Induced]

This case has an expert witness opinion from a GI doc.

Patient was started on Depakote, LFTs were initially fine.

Within 5 weeks she had a liver transplant.

The expert notes that she had positive ASMA and ANA titers and homozygous positive for H63D hemochromatosis. Do these results suggest that there may be an alternative cause for her liver failure?

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[hemosuccus]

Link to case here: Liver Failure [Medication-Induced]

This case has an expert witness opinion from a GI doc.

Patient was started on Depakote, LFTs were initially fine.

Within 5 weeks she had a liver transplant.

The expert notes that she had positive ASMA and ANA titers and homozygous positive for H63D hemochromatosis. Do these results suggest that there may be an alternative cause for her liver failure?

Purely from a theoretical discussion, if the liver biopsy was concerning for AIH the transplant liver team would have looked into it, its low hanging fruit. HH doesn't cause ALF and H63D doesn't cause iron overload anyway.

 

[cabergoline2]

Link to case here: Liver Failure [Medication-Induced]

This case has an expert witness opinion from a GI doc.

Patient was started on Depakote, LFTs were initially fine.

Within 5 weeks she had a liver transplant.

The expert notes that she had positive ASMA and ANA titers and homozygous positive for H63D hemochromatosis. Do these results suggest that there may be an alternative cause for her liver failure?

+ASMA does not mean autoimmune hepatitis. In fact most weakly positive ASMA are not AIH. H63D is not clinically signifant... what happened here is Fulminant liver failure as a result of idiosyncratic drug reaction... It is clear that failure to get LFTs by NP led to delay in diagnosis. however if it was fulminant liver failure from DILI which ultimately led to a transplant , early diagnosis may not have changed outcomes in this case... had there been further delays in Diagnosis and she became too sick to be transplanted and died , than it would have changed outcomes.. there is no good treatment for fulminant liver failure other than transplant... they could have tried NAC drip but likely would not have worked...