Acute Hepatitis with the Tramadol-Paracetamol Combination; About an Observation at The Regional University Hospital Center of Ouahigouya in Burkina Faso and Review of the Literature

Introduction: Idiosyncratic drug hepatotoxicity called drug-induced liver injury (DILI) is a major problem in modern hepatology. However, it remains underdiagnosed and relatively rare. We report a case of acute hepatitis due to tramadol associated with paracetamol in a hospital setting in Ouahigouya (Burkina Faso). Case History: a 20-year-old male gardener presented, following hospitalization in July 2023, with clinical cholestasis syndrome after taking tramadol and paracetamol as an adjuvant to anti-malaria treatment. No pathological history was found. There was no notion of alcohol consumption or taking hepatotoxic medication before hospitalization. The clinical examination revealed flamboyant jaundice, the biology revealed syndromes of cholestasis, cytolysis and hepatocellular insufficiency. The markers of viral hepatitis A B, and C as well as those of autoimmunity were negative. The hepatobiliary and other abdominal organs ultrasound was normal. Therapeutically, we stopped tramadol and paracetamol. The evolution was favorable after 15 days with first a normalization of clinical parameters and a clear improvement in biological parameters, then their normalization 1 month after hospitalization. Conclusion: We report a documented observation of “mixed” acute hepatitis (cytolytic and cholestatic) in connection with the concomitant use of tramadol and paracetamol, with a favorable outcome in the absence of re-exposure to the drug after 45 days.