Human cholestatic hepatitis owing to polyoxyethylene nonylphenol ingestion: A case report. Issue 32 (August 2017)

• Record Type: Journal Article
• Authors: Min, Jihye; Han, Joohye; Kim, Kyungju; Park, Samel; Lee, Sunhyo; Hong, Jungrak; Gil, Hyowook; Song, Hoyeon; Hong, Saeyong
• Other Names: Tarantino. Giovanni section editor.
• Is Part Of: Medicine. Volume 96:Issue 32(2017)
• Publication Date: 2017-08
• Subjects: cholestatic hepatitis -- iminoctadine triacetate -- pesticide poisoning -- polyoxyethylene nonylphenol -- surfactants; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000007737
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: The purpose of this study was to identify the chemical responsible for cholestatic hepatitis in a 55-year-old woman who ingested 1, 1′-iminodi (octamethylene) diguanidinium triacetate (iminoctadine triacetate), a fungicide. The fungicide formulation was also composed of polyoxyethylene nonylphenol (NP-40) and methanol. Patient concerns: Severe cholestatic hepatitis developed, which led to the patient's death on day 88 of hospitalization. Post-mortem necropsy of the liver showed focal hepatocyte necrosis involving mostly the mid-zone, along with intracytoplasmic and intracanalicular cholestasis. Diagnoses: To identify the chemical responsible for hepatic injury, the cellular toxicity of all chemicals in the fungicide formulation was assessed in HepG2 cells using the 3-(4, 5-dimethylthiaxol-2yl)-2, 5-diphenyl tetrazolium bromide test. Outcomes: Viability of cells treated with the surfactant NP-40 was significantly lower ( P < .001), but that of cells treated with other components of the fungicide, including the active ingredient, iminoctadine triacetate, was unaffected. Fluorescence-activated cell sorting analysis confirmed that necrosis was induced in HepG2 cells treated with 25–80 μM of NP-40, while significant numbers of apoptotic cells were not detected. Lessons: NP-40 appears to be the chemical responsible for the patient's irreversible hepatic injury, accompanied by intracytoplasmic and intracanalicular cholestasis.