<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0872-671X</journal-id>
<journal-title><![CDATA[Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Medicina Interna]]></abbrev-journal-title>
<issn>0872-671X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0872-671X2024000400039</article-id>
<article-id pub-id-type="doi">10.24950/rspmi.2520</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[A Rare Case of Dapagliflozin-Induced Hepatic Toxicity]]></article-title>
<article-title xml:lang="pt"><![CDATA[Um Caso Raro de Toxicidade Hepática Induzida por Dapagliflozina]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernandes]]></surname>
<given-names><![CDATA[Catarina Borges]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramalho]]></surname>
<given-names><![CDATA[Paulo Torres]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital CUF Porto Serviço de Medicina Interna ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2024</year>
</pub-date>
<volume>31</volume>
<numero>3</numero>
<fpage>39</fpage>
<lpage>42</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0872-671X2024000400039&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0872-671X2024000400039&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0872-671X2024000400039&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Drug-induced liver injury is a challenging clinical condition in terms of both diagnosis and treatment. It presents a wide range of clinical manifestations, and identification of the implicated substance is crucial. Several adverse effects have been described in association with dapagliflozin, but not liver enzyme elevation. The authors present the case of a 71-year-old diabetic woman who developed gastrointestinal symptoms one month after increasing the dose of dapagliflozin. Liver en-zyme elevation was observed, without evidence of obstructive causes on imaging exams. Other causes of liver disease were excluded, and liver biopsy favored a toxic/drug etiology. Liver enzyme normalization was observed after discontinuation of dapagliflozin. Liver injury associated with sodium-glucose co-transporter 2 inhibitors is very rare, and the authors aim to raise awareness about the potential hepatotoxic effects of dapagliflozin, highlighting the importance of early diagnosis and appropriate treatment.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo A lesão hepática induzida por fármacos é uma situação clínica desafiadora no que respeita quer ao diagnóstico, quer ao tratamento. Apresenta um amplo espetro de manifestações clínicas e a identificação da substância implicada é fundamental. Vários efeitos adversos foram associados à dapaglifozina, mas não o aumento das enzimas hepáticas. Os autores apresentam o caso de uma mulher de 71 anos, diabética, que desenvolveu náuseas e dor abdominal um mês após aumentar a dose de dapaglifozina. Verificou-se elevação das enzimas hepáticas, sem evidência de causa obstrutiva nos exames de imagem. Foram excluídas outras causas de doença hepática e a biópsia hepática favoreceu a etiologia tóxica/medicamentosa. Verificou-se normalização das enzimas hepáticas após a suspensão da dapaglifozina. A lesão hepática associada aos inibidores da proteína transportadora sódio--glicose 2 é muito rara e os autores pretendem aumentar a consciencialização sobre os potenciais efeitos hepatotóxicos da dapagliflozina, alertando para um diagnóstico precoce e tratamento adequado.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Chemical and Drug Induced Liver Injury]]></kwd>
<kwd lng="en"><![CDATA[Dapagliflozin]]></kwd>
<kwd lng="en"><![CDATA[Sodium-Glucose Transporter 2 Inhibitors/adverse effects.]]></kwd>
<kwd lng="pt"><![CDATA[Dapagliflozina]]></kwd>
<kwd lng="pt"><![CDATA[Inibidores da Proteína Transportadora Sódio-Glicose 2/efeitos adversos]]></kwd>
<kwd lng="pt"><![CDATA[Lesão Hepática Induzida por Fármacos.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nunes]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Lima]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Um raro caso de hepatotoxicidade induzida pela empagliflozina]]></article-title>
<source><![CDATA[Med Interna]]></source>
<year>2021</year>
<volume>28</volume>
<page-range>357-61</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<collab>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]</collab>
<source><![CDATA[]]></source>
<year>2012</year>
<publisher-loc><![CDATA[Bethesda(MD) ]]></publisher-loc>
<publisher-name><![CDATA[National Institute of Diabetes and Digestive and Kidney Diseases]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ptaszynska]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Johnsson]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Parikh]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[de Bruin]]></surname>
<given-names><![CDATA[TW]]></given-names>
</name>
<name>
<surname><![CDATA[Apanovitch]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[List]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Safety profile of dapagliflozin for type 2 diabetes pooled analysis of cli-nical studies for overall safety and rare events]]></article-title>
<source><![CDATA[Drug Saf]]></source>
<year>2014</year>
<volume>37</volume>
<page-range>815-29</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Levine]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Ann Lo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Wallia]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rogers]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[VanWagner]]></surname>
<given-names><![CDATA[LB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dapagliflozin-Induced Acute-on-Chronic Liver Injury]]></article-title>
<source><![CDATA[ACG Case Rep J]]></source>
<year>2016</year>
<volume>3</volume>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Danan]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Teschke]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[RUCAM in Drug and Herb Induced Liver Injury The Update]]></article-title>
<source><![CDATA[Int J Mol Sci]]></source>
<year>2015</year>
<volume>17</volume>
<page-range>14</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hoofnagle]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
<name>
<surname><![CDATA[Björnsson]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Drug-Induced Liver Injury - Types and Phenotypes]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2019</year>
<volume>381</volume>
<page-range>264-73</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<collab>European Association for the Study of the Liver</collab>
<article-title xml:lang=""><![CDATA[EASL Clinical Practice Guidelines: Drug-induced liver injury]]></article-title>
<source><![CDATA[J Hepatol]]></source>
<year>2019</year>
<volume>70</volume>
<page-range>1222-61</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Famularo]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Sajeva]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Marino]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Granato]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute hepatitis caused by empagliflozin in a nonalcoholic fatty liver disease patient]]></article-title>
<source><![CDATA[Ann Pharmacother]]></source>
<year>2017</year>
<volume>51</volume>
<page-range>1142-3</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
