This was one of the earliest reported cases of acute liver failure attributed to nimesulide. The latency to onset was actually quite short, within 2 weeks of starting. Symptoms were vague and not specific. Her liver tests were abnormal, but nimesulide was continued. She continued to feel worse and eventually developed jaundice followed by hepatic failure. She was acutely ill on hospital admission and was rapidly listed for emergency liver transplantation, which was carried out on day 3. She suffered primary graft nonfunction, however, and died of multiorgan failure. The majority of cases of acute liver failure due to nimesulide have been in middle aged women with onset within 2 weeks to 3 months of starting. The shorter latencies may correlate with previous exposure.
NSAIDS have antipyretic activity and can be used to treat fever.   Fever is caused by elevated levels of prostaglandin E2 , which alters the firing rate of neurons within the hypothalamus that control thermoregulation.   Antipyretics work by inhibiting the enzyme COX, which causes the general inhibition of prostanoid biosynthesis ( PGE2 ) within the hypothalamus .   PGE2 signals to the hypothalamus to increase the body's thermal set point.   Ibuprofen has been shown more effective as an antipyretic than paracetamol (acetaminophen).   Arachidonic acid is the precursor substrate for cyclooxygenase leading to the production of prostaglandins F, D & E.