case_images: PMC9428317_01
case_images: Timeline of the case. (A) Time course relative to initiation of POTABA treatment. (B) Levels of transaminases (ALT and AST, plotted to the left axis) and total bilirubin levels (plotted to the right axis) after withdrawal of POTABA. Abbreviations: ALT, alanine transaminase; AST, aspartate aminotransferase; HLA-DR, human leukocyte antigen receptor; NAC, N-acetyl cysteine; POTABA, potassium para-aminobenzoate.
case_images: fphar-13-966910-g001.jpg
case_images: PMC9428317_01_fphar-13-966910-g001.jpg
case_images: F1
case_images: A 73-year-old man presented to our emergency department with a history of dark yellow urine for 2 weeks, as well as jaundice for 3 days (Figure 1A). The patient had a prior history of Peyronie's disease treated with POTABA for 7 weeks before admission, no other medication was present (Figure 1A). For supportive therapy, POTABA treatment was withdrawn and N-acetyl cysteine (NAC) as well as intravenous rehydration was initiated (Figure 1A). Clinical jaundice further resolved until an ambulatory follow-up 10 days after discharge, associated with further improvement of transaminases (ALT: 1,197 U/L, normal range: <=45 U/L; AST: 139 U/L, normal range: <=35 U/L), and total bilirubin levels (3.4 mg/dl, normal range: 0.3-1.2 mg/dl, Figure 1A).
case_images: Kinetics of HLA-DR+ T lymphocytes associate with recovery from hepatotoxicity induced by POTABA. (A,B) Monitoring of circulating total and HLA-DR+ monocytes (CD14+ HLA-DR+) and T lymphocytes (CD3+ HLA-DR+) by flow cytometry revealed that improvement of liver injury after POTABA withdrawal resulted in a rapid decline of absolute CD3+ HLA-DR+ T lymphocyte counts, while CD14+ HLA-DR+ monocytes remained unaffected. (C) Fraction of HLA-DR+ cells within the total monocyte (CD14+) and T lymphocyte (CD3+) populations confirm that improvement of liver injury after POTABA withdrawal resulted in a rapid decline of relative CD3+ HLA-DR+ T lymphocyte counts. Abbreviations: HLA-DR, human leukocyte antigen receptor; POTABA, potassium para-aminobenzoate.
case_images: fphar-13-966910-g002.jpg
case_images: PMC9428317_01_fphar-13-966910-g002.jpg
case_images: F2
case_images: Flow cytometry measurements of circulating activated monocytes and T lymphocytes reflected by cell surface HLA-DR expression revealed presence of HLA-DR on the surface of monocytes (CD14+ HLA-DR+: 185 cells/microL, 99.7% of the CD14+ population) and T lymphocytes (CD3+ HLA-DR+: 479 cells/microL, 39.2% of the CD3+ population, Figures 2A,B; Table 3). CD3+ HLA-DR+ T lymphocyte counts within the total population (Figures 2A-C; Table 3). Contrasting to this observation, absolute and relative counts of CD14+ HLA-DR+ monocytes remained unaffected (Figures 2A-C; Table 3).