Nimesulide-induced fulminant hepatitis.

An 18-year-old boy was brought to the hospital with jaundice, confusion, abdominal discomfort and distension. He had a history of oral intake of nimesulide for three days. Clinical and laboratory findings were compatible with fulminant hepatitis. Exclusion of other causes of liver injury strongly favored drug-induced toxicity. All of the signs, symptoms and laboratory abnormalities returned to normal after cessation of the nimesulide and supportive treatment, and he was discharged on the 15th day after admission. This case differs from the other cases in the literature regarding the time of onset, and indicates that nimesulide may induce fulminant hepatitis in the first few days of administration. Therefore, patients receiving nimesulide should be frequently monitored with serial serum transaminases, beginning from the first week of intake.