Advances in clinical differentiation between immunological and drug-induced liver injury / 中华肝脏病杂志

The differentiation between autoimmune hepatitis (AIH) and drug-induced liver injury (DILI) is a difficult task in clinical practice. Some AIH patients had a medication history before disease onset, and some DILI patients may have positive serum antibody. In addition, these two groups of patients have similar clinical symptoms, serological examination results, and liver histopathology, which lead to the difficulties in differentiation. However, correct differential diagnosis is of great significance in making clinical treatment decisions and preventing liver cirrhosis. Therefore, it is necessary to investigate the association between immunological and drug-induced liver injury from the perspectives of pathogenesis, similarities and differences in clinical features, serological examination results, and histological changes, prospects of new biomarkers in differentiation, and the significance of hormone therapy and clinical follow-up in differential diagnosis and treatment, in order to provide a reference for clinical decision-making and research in future.

Epidemic features, major causes, and diagnostic evaluation of herb-induced liver injury / 临床肝胆病杂志

With the wide application of Chinese herbal medicine around the world and the continuous perfection of adverse drug reaction monitoring system,herb-induced liver injury (HILI) has attracted more and more attention,but its actual incidence remains unknown.As is reported in the literature,its constituent ratio ranged from 20％ to 30％ and there are many clinical types,among which hepatocellular injury is the most common type.There are many causes of HILI,including pharmaceutical factors,factors associated with the human body,lack of preclinical evaluation,and unreasonable clinical application.Currently it is difficult to make a diagnosis of HILI,and tracing the source of Chinese herbal medicine may play an important role in the diagnosis of this disease.Liver injury induced by Chinese herbal medicine should be taken seriously and active diagnosis and effective prevention and treatment should be performed.

Research advances in drug-induced liver injury in the elderly / 临床肝胆病杂志

Nowadays, drug-induced liver injury (DILI) is attracting more and more attention during clinical medication and drug research and development. This article introduces the characteristics of DILI in the elderly from the aspects of epidemiology, predisposing factors, clinical features, common drugs inducing DILI, and prognosis, and points out that the health education for the elderly should be enhanced and the elderly should be instructed to use drugs rationally. When adverse events occur, treatment should be given in time and treatment regimen should be adjusted.

Clinical features of drug-induced liver injury and primary biliary cirrhosis: a comparative analysis / 临床肝胆病杂志

ObjectiveTo investigate and compare the clinical features of drug-induced liver injury (DILI) and primary biliary cirrhosis (PBC). MethodsA total of 116 PBC patients and 124 DILI patients who were diagnosed in Shengjing Hospital of China Medical University from January 2005 to December 2013 were enrolled, and clinical features, laboratory indices, and the results of liver biopsy were compared between the two groups. The t-test or Nemenyi rank sum test was applied for comparison of continuous data between the two groups, and the chi-square test was applied for comparison of categorical data between the two groups. ResultsThere were significant differences in age of onset and gender composition between the two groups(both P＜005). The serological markers (except albumin), immunological indicators (IgG, IgM, and IgA), and positive rate of autoantibodies (except SMA) showed significant differences between the two groups (all P＜0.05). The histological appearances of PBC were hepatocyte edema (30 patients), inflammatory cell infiltration around the bile duct (29 patients), and atypical hyperplasia of the small bile duct (28 patients), and those of DILI were hepatocyte steatosis (15 patients) and spotty necrosis and loss of hepatocytes (14 patients). ConclusionDILI and PBC are different in the aspects of laboratory tests and pathological examinations, which has a certain guiding significance in differential diagnosis in clinical practice.

Clinical effect of entecavir combined with antituberculosis therapy in patients with tuberculosis complicated by chronic HBV infection / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of entecavir combined with antituberculosis therapy in patients with tuberculosis complicated by chronic HBV infection. MethodsA total of 108 patients with tuberculosis complicated by chronic HBV infection were divided into entecavir group with 58 patients and control group with 50 patients. The patients in the entecavir group were given entecavir from 1 month before antituberculosis therapy to the end of antituberculosis therapy, and those in the control group were given antitubercular agent alone. The incidence of liver injury and clinical symptoms, time to appearance of abnormal liver function, and time to liver function recovery were compared between the two groups. The two-independent-samples t test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsCompared with the control group, the entecavir group had significantly higher incidence rates of abnormal liver function (29.31% vs 64.00%, χ2=8.475, P＜0.05) and clinical symptoms of liver injury (17.24% vs 28.00%, χ2=5.534, P＜0.05). There were significant differences in the time to appearance of abnormal liver function (25.1±10.2 d vs 20.1±8.9 d, t=2.675, P＜0.05) and time to liver function recovery (26.5±9.8 d vs 32.6±11.2 d, t=3.778, P＜0.05). ConclusionEntecavir can significantly reduce the incidence of liver injury caused by antituberculosis therapy, postpone the time to appearance of liver injury, and accelerate liver function recovery in patients with tuberculosis complicated by chronic HBV infection.

Four Cases of Toxic Hepatitis after Ingestion of Sea Hare / 대한내과학회지

The sea hare is a marine mollusk in the family Aplysiidae that has long been consumed as food. Rarely, toxic hepatitis can occur after eating sea hare. We herein discuss four cases of toxic hepatitis due to sea hare ingestion and review the relevant literature.

Hepatoprotective effect of Evodia officinalis Dode on carbon tetrachloride induced liver injury in rats / 中国医师杂志

Objective To investigate the protective effect of ethanol extract from Evodia officinalis Dode(EEEO) in a rat model of acute hepatic necrosis induced by carbon tetrachloride (CCl4).Methods Wistar rats were divided into four groups (control,CCl4,EEEO + CCl4,and Silmyarin + CCl4),the four groups were given intragastrically with normal saline,EEEO for 5 d,respectively.In the last one day,these groups except for control group were injected peritoneally with CCl4.Serum levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP) were detected by automatic biochemistry analyzer.Pathological changes of hepatic tissues were assessed by hematoxylin-eosine (HE) staining.The levels of superoxide dismutase (SOD),catalase (CAT) and malondialdehyde (MDA) in liver homogenate were analyzed using xanthinoxidase and thio-barbituric acid,respectively.Results Compared the ALT [(345.4 ±51.6)U/ml] and AST [(621.7 ± 143.5) U/ml)] of CCl4 group with ALT [(41.1 ± 2.2) U/ml] and AST [(85.2 ± 22.2) U/ml] of control group,the serum levels of ALT and AST in the CCl4 group were increased significantly (P ＜ 0.05).HE staining of liver tissue,the degeneration and necrosis were implicated to the whole hepatic lobules in the CCl4 group.In EEEO + CCl4 group,compared the ALT [(308.1 ± 44.6) U/ml] and AST [(546.4 ± 131.6) U/ml] of low dose EEEO + CCl4 group with the ALT [(210.6 ±34.5) U/ml] and AST [(379.3 ± 112.3) U/ml] of high dose EEEO +CCl4 group the serum levels of ALT and AST were decreased significantly in low dose EEEO + CCl4 group (P ＜0.05).The denaturation and necrosis of hepatic lobules,the level of SOD,CAT were increased and MDA decreased (P ＜ 0.05) inendochylema.Concluslons EEEO can significantly relieve the CCl4-induced hepatonecrosis.The role may be related to anti-lipid peroxidation.

Study on the isoniazid induced cellular damage and the expressions of Fas/Fas ligand of HepG2 / 中华传染病杂志

Objective To establish a model of isoniazid induced necrosis and apoptosis in HepG2 cell and to observe the expressions of Fas/Fas ligand (FasL) in this model.Methods HepG2 cells were treated with different dosages of isoniazid (0,1,2,4,6 and 8 mg/mL) or blank control for 24 hours.Flow cytometer was used to observe the cellular morphology of the HepG2 cell.Annexin V/propidium iodide double staining and flow cytometry were employed to detect the necrosis and apoptosis of HepG2 cells.The expressions of Fas/FasL on the cells were also determined by flow cytometry.The data were analyzed by one-way ANOVA.The comparisons between the drug groups and the control group were performed by using Dunnett t test. Results The higher the dose of isoniazid (4,6,8 mg/mL) was,the more necrosis and apoptosis were observed.In the 4,6 and 8mg/mL isoniazid arms,the total mortality rates were all higher than the control group [(32.1 ±7.5)％,(34.9±8.1)％,(38.2±9.4)％ vs (7.2±1.5)％ respectively](t=4.62,5.14 and 5.75,respectively; all P＜0.01 ).The expression levels of Fas increased along with the dose of isoniazid increasing [(8.7±2.2)％,(11.5±2.8)％,(12.3±3.0)％ and (10.6±2.9)％ in isoniazid 2,4,6and 8 mg/mL arms,respectively],which were all higher than that in control arm [(3.1 ±0.8) ％](t=2.97,P＜0.05; t=4.46,P＜0.01; t=4.88,P＜0.01; t=3.98,P＜0.05).Furthermore,the expressions of FasL increased as well when the dose of isoniazid increased.The expression levels of FasL were (16.2±3.5)％,(21.7±4.8)％ and (18.7±4.9)％,respectively in isoniazid 4,6 and 8 mg/mL arms,which were all higher than that in the control group [(7.4±1.4)％](t=3.11,P＜0.01; t=5.06,P＜0.01; t=3.99,P＜0.05).HepG2 cell necrosis increased with isoniazid of 8 mg/mL.However,the increase of apoptosis was not observed.Conclusion Isoniazid can induce HepG2 cell necrosis and apoptosis,and the apoptosis may be related with the increased expressions of the Fas/FasL on the cells.

The role of CD4+CD25+ regulatory T cells in peripheral blood and intestinal endotoxin in liver injury of rat severe acute pancreatitis / 中华肝胆外科杂志

ObjectiveTo investigate the role of CD4+ CD25+ regulatory T cells(Treg) in peripheral blood and intestinal endotoxin (ET) in liver injury of rat severe acute pancreatitis (SAP).MethodsSixty male Wistar rats were randomly allocated into sham operation group(SO group) and severe acute pancreatitis group(SAP group).The rats in SAP group recevied the injection of Sodium Taurocholate(NaTc) into their far-end of bile-pancreatic duct and were sacrificed in 3-,6-and 12-hour,serum amylase(AMY) and alanine aminotransferase(ALT) determined by full-automatic biochemistry instrument,limulus reagent method is used to determine ET content in plasma,the proportion of Treg among peripheral lymphocytes was determined by Flow Cytometry(FCM),HE stain is used to observe pathological changes in liver and pancreas,the protein of Foxp3 activity was evaluated by immunohistochemistry staining,and the relationships between these indicators were analyzed using Pearson correlation analysis test.ResultsHistopathologic examination and the level of ALT revealed the occurrence of pancreatic inflammation and pathological changes of liver in SAP group.The percentage of Treg in SAP groups significantly increased at 3 h(2.26％ ±0.32％),6 h(2.36 ％ ±0.48％)and 12 h(2.80％ ±0.35％) comparing to the SO groups(P＜0.01) ; plasma ET levels compared with the SO group was statistically significant (P＜ 0,01 ),and 12 h (0.85 ± 0.11) compared to,3 h (0.74±0.11) and 6 h (0.78-±-0.07) was no significant difference (P＞0.05).The expression of Foxp3 protein on the livers were upregulated markedly.Pearson correlation analysis teat showed that quantities of Treg were positively proportional to the levels of ET(r=0.89,P＜0.01) after liver injury of SAP.ConclusionsSAP may lead to liver injury and the high plasma levels of ET and Treg in peripheral blood may play an important role in liver injury of SAP.

Antituberculosis drugs induce mitochondrial oxidative damage of hepatocytes / 中华传染病杂志

ObjectiveTo study the influence of anti-tuberculosis drugs on mitochondrial function in mice hepatocytes and to explore the mechanism of the anti-tuberculosis drugs induced liver injury.Methods A total of 150 mice were randomized into five groups:control group (C group),rifampin (RFP) group,isoniazid (INH) group,pyrazinamide (PZA) group and three antituberculosis drug combination group (MIX).The mice were administered intragastrically with 0.9 ％ NaC1 solution or RFP 135 mg · kg-1 · d-1 or INH 90 mg · kg-1 · d-1 or PZA 315 mg · kg-1 · d-1 or RFP+INH+ PZA (135±90+315) mg · kg-1 · d-1 once a day.Ten mice in each group were sacrificed at day 3,7 and 15 of administration,respectively.The following parameters in each group were monitored.the concentration of malondialdehyde (MDA),the activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) in mitochondrion of hepatocytes and the concentration of 8-hydroxydeoxyguanosine (8-OH-dG) in mitochondrial DNA (mtDNA).The data were analyzed by one-way ANOVA or rank sum test.Results Along with the prolonged medication duration,the concentrations of MDA all gradually increased in RFP group (Z=6.020,P=0.049),IN H group (Z=10.220,P=0.006) and MIX group (Z=7.460,P=0.024),whereas the activity of SOD significantly decreased in RFP group (F=6.751,P =0.011 ) and MIX groups (F=4.891,P =0.041 ) compared with control group and PZA group.Meanwhile,the activity of GSH-PX was significantly lower in RFP group compared to the other groups (F=32.445,P＜0.01).The changes of other parameters didn't show meaningful trend.The concentrations of 8-OH-dG in mtDNA also increased in all treated groups,and those were all significantly increased in RPF group (F=6.602,P＜0.01 ),PZA group (F=5.927,P＜0.01) and MIX groups (F=7.974,P＜0.01).Conclusions Antituberculosis drugs can induce higher MDA concentration in mitochondrion and higher 8-OH-dG concentration in mtDNA,while result in lower activities of SOD and GSH-PX.The liver damage tends to become more severe along with the prolonged medication duration.The combination of three antituberculosis drugs could aggravate the damage of mitochondrion in mice hepatocytes.

Clinical analysis of drug-induced liver injury in the elderly / 中华老年医学杂志

Objective To investigate the causes, clinical features, classifications and liver function change of drug-induced liver damage (DILD) in the elderly. Methods One hundred and sixty seven inpatients with acute drug-induced liver injury in our hospital in the past ten years (January 2000 to December 2009) were retrospectively investigated,and the diagnosis and classification methods of acute DILD were based on international consensus meeting (international criteria). Results Among 167 DILI cases, there were 53 cases (31.7%) in the older group and 114 cases (68.3%) in middle-youth age group. Fatigue and jaundice were the more common symptoms, accounting for 50.3% and 46.7%, respectively. In 167 cases, no obvious symptoms and signs were shown in 25 cases. There were no significance differences in clinical manifestation between two groups. Many drugs could induce liver injury. The most common drugs inducing DILD were Chinese traditional and herbal drugs, accounting for 47.9%. Drugs used in heart diseases and inducing liver injury were more common in the older group. In this study, 40 (75.5%), 5 (9.4%) and 8 (15.1%) cases were designated as hepatocellular, cholestetic and mixed DILD in the older group, and 91 (78.9%), 8 (7.4%) and 15 (13.7%) in middle-youth age group, respectively. There were no significance differences between two groups in classifications. Conclusions Many drugs could cause liver injury. The symptoms of acute DILD are nonspecific. Drugs used in heart diseases and inducing liver injury are more common in older patients.

Aloe-induced Toxic Hepatitis

Aloe has been widely used in phytomedicine. Phytomedicine describes aloe as a herb which has anti-inflammatory, anti-proliferative, anti-aging effects. In recent years several cases of aloe-induced hepatotoxicity were reported. But its pharmacokinetics and toxicity are poorly described in the literature. Here we report three cases with aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a 55-yr-old woman were admitted to the hospital for acute hepatitis. They had taken aloe preparation for months. Their clinical manifestation, laboratory findings and histologic findings met diagnostic criteria (RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. Aloe should be considered as a causative agent in hepatotoxicity.

Protective effects of cordyceps sinensis and mycelium of cultured sinensis on acute liver injury and expression of CYP450 induced by Carbon Tetrachloride / 中国基层医药

Objective To investigate the effect of Cordyceps Sinensis and Mycelium of Cultured Sinensis on acute injury in this test and expression of CYP450. Methods Mice received a single dose of 0. 1% CCl_4 i. p, after CCl_4 intoxication,mice received Cordyceps Sincnsis and Mycelium of Cultured Sinensis (100mg/ml) 3 times per six hour,then the mice sacrificed at 6h,12h,24h,the levels of aminotransferase (ALT) and glutathione (GSH) in ser-um,CYP45 content in hepatic microsomal activity in fiver homogenate were measured. Results Mice given Cordyceps Sinensis and Mycelium of Cultured Sinensis supplement had less elevation of serum ALT concentration, Cordyceps Sinensis and Mycelium of Cultured Sinensis administration restored the reduction of hepatic microsomal P450 protein content as well as inducing an increase in hepatic GSH concentration. Additionally, Cordyceps Sinensis and Mycelium of Cultured Sincnsis treatment inhibited the elevation of hepatic CYP450 protein after CCl_4 intoxication. Condusion The protect effect of Cordyceps Sinensis and Mycelium of Cultured Sinensis may be due to its abilitity to increase CYP450 content which decreased in CCl_4-induced liver in combination with increasing the activities of antioxidant en-zyme.

A case of acute cholestatic hepatitis induced by Corydalis speciosa Max / 대한간학회지

Herbs are widely used as treatments for various symptoms. However, several herbs have been reported to be inducers of liver injury. We report herein a case of hepatotoxicity induced by Corydalis speciosa Max. A 37-year-old male complained of jaundice and mild abdominal discomfort. A thorough history was taken, and laboratory investigation, diagnostic imaging studies, and percutaneous liver biopsy sampling were conducted to determine the cause of liver injury. An accurate cause was not revealed. We administered supportive management for acute cholestatic hepatitis of unknown origin, after which his symptoms disappeared and serum aminotransferase levels decreased gradually to near normal levels. However, at 2 months after discharge, the symptoms and the elevation of aminotransferase levels recurred. At that time he told us that he had repeatedly but unintentionally eaten a herb called "Hwang-geun cho"(Corydalis speciosa Max.). Thus, we diagnosed his case as herbal hepatotoxicity.

A case of fulminant hepatic failure due to cyproterone acetate in a patient with cryptogenic liver cirrhosis / 대한내과학회지

Cyproterone acetate is an antiandrogenic drug that has been used in prostatic cancer. The drug is thought to be well-tolerated but has hepatotoxic effects. An 89 year-old man treated with cyproterone acetate 300 mg/d for prostatic cancer presented with a hepatotoxic reaction. Toxic hepatitis was diagnosed and cyproterone acetate was stopped immediately. The patient was treated with supportive management and a corticosteroid, but he died 28 days after administration due to liver failure. A liver biopsy performed after his death revealed the presence of acute hepatitis with cirrhosis. Underlying cirrhosis was not suspected before his death. Ultimately, the case was diagnosed as fulminant hepatic failure due to cyproterone acetate with underlying cryptogenic liver cirrhosis. This case and current literature highlight the hepatotoxic potential of cyproterone acetate and illustrate the importance of clinical surveillance, especially in patients with unrecognized liver disease.

Efeitos adversos no tratamento da tuberculose: experiência em serviço ambulatorial de um hospital-escola na cidade de São Paulo / Adverse effects of tuberculosis treatment: experience at an outpatient clinic of a teaching hospital in the city of São Paulo, Brazil

OBJETIVOS: Verificar a freqüência de efeitos adversos com o uso do Esquema I para tratamento da tuberculose e a necessidade de alterações no tratamento devido a esses efeitos. MÉTODOS: Foi feita uma análise retrospectiva de 329 prontuários de pacientes que foram tratados com o Esquema I e receberam alta por cura entre março de 2000 e abril de 2006 no Ambulatório de Tuberculose da Clínica de Pneumologia da Santa Casa de Misericórdia de São Paulo. Foram analisados os dados referentes aos efeitos adversos, época de seu aparecimento e modificações do esquema de tratamento subseqüentes. RESULTADOS: Foram incluídos 297 pacientes, e 146 (49,1 por cento) apresentaram um ou mais efeitos adversos relacionados às drogas antituberculose. A freqüência dos efeitos colaterais menores foi de 41,1 por cento, e a dos efeitos maiores foi de 12,8 por cento. Os efeitos relacionados ao trato gastrointestinal (40,3 por cento) e pele (22,1 por cento) foram os mais freqüentes. Os efeitos adversos foram mais freqüentes nos primeiros dois meses de tratamento (58,4 por cento). Houve necessidade de modificação do esquema de tratamento em 11 casos (3,7 por cento do total). A hepatite induzida por medicamentos foi o efeito colateral que mais exigiu modificações. CONCLUSÕES: A freqüência de efeitos adversos relacionados ao tratamento da tuberculose com o Esquema I foi de 49,1 por cento neste grupo de pacientes. Entretanto, na maioria dos casos, não houve necessidade da modificação do esquema de tratamento devido aos efeitos adversos.

OBJECTIVES: To determine the frequency of adverse effects related to the use of the tuberculosis treatment regimen designated Regimen I and the need for regimen alterations due to these effects. METHODS: A retrospective analysis of 329 medical charts of patients who were treated with Regimen I and discharged after cure between March 2000 and April 2006 was carried out at the Tuberculosis Outpatient Clinic, Department of Pulmonology of the Santa Casa de Misericórdia de São Paulo Hospital in the city of São Paulo, Brazil. Adverse effects and the timing of their appearance, as well as subsequent modifications in the treatment regimen, were investigated. RESULTS: We included 297 patients, 146 (49.1 percent) of whom presented one or more adverse effects related to antituberculosis medications. The frequency of minor side effects was 41.1 percent, and that of major side effects was 12.8 percent. The most common reactions were those involving the gastrointestinal tract (40.3 percent) and the skin (22.1 percent). Adverse effects were more common in the first and second months of treatment (58.4 percent). Modification of the treatment regimen was necessary in 11 cases (3.7 percent of the total sample). Drug-induced hepatitis was the adverse effect that demanded the most regimen changes. CONCLUSIONS: In this group of patients, the frequency of adverse effects related to treatment with Regimen I was 49.1 percent. However, in most of the cases, it was not necessary to modify the treatment regimen due to side effects.

Acute Drug-Induced Hepatitis Caused by Albendazole

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.

The Survey for the Actual Condition of Drug Medication and Development of Health Care Cost Associated with Toxic Liver Injury in Korean; A Multicenter Study for the Detection and the Development of Nationwide Reporting System of Toxic Liver Injury / 대한간학회지

BACKGROUNDS/AIMS: In Korea, interests in health and health care costs have been increased along with the increase of mean survival rate and income level. The aim of this study is to investigate the actual condition of drug medication and burden of health care cost. METHODS: A total of 1,434 subjects in four tertiary medical centers were enrolled in this study. The questionnaires were obtained between March 2005 and September 2005. Based on this information, the actual condition of drug medication and health care cost were analyzed. RESULTS: The mean age of the subjects was 55.0+/-11.4 years (16-87 years). The male and female ratio was 1.74:1. The subjects with drug medication except for doctor's prescription are presently 26.6% and were 40.9% in the past. Traditional medicine (39.6%) and health food (29.9%) are more frequently used than herbal medicine (5.8%) and medical supplies (4.2%) now. In the past, herbal medicine (14.6%) was more frequently used compared with the present. The side effects of drug medication were developed in 90 subjects (7.5%). The total mean health care costs were 895,000 won/year, the herbal medicine, 834,000 won/year, the health food, 950,000 won/year, and the traditional medicine, 324,000 won/year. CONCLUSIONS: In this study, the subjects with other drug medications without doctor's prescription were as high as ever. The frequency of the use of the herbal medicine was decreased. However, the frequency for the use of the health food and traditional medicine have relatively increased. The side effects and additional large amounts of health care costs were occurred.

Alfuzosin-induced Acute Liver Injury / 대한간학회지

We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.

Clinical Characteristics of Acute Toxic Liver Injury / 대한간학회지

BACKGROUND/AIMS: Recently, acute toxic liver injury has been reported to be the most common cause of acute hepatitis. The frequency and clinical manifestations of acute toxic liver injury was evaluated. METHODS: The medical records of 68 patients demonstrating clinically significant acute toxic liver injury were retrospectively reviewed. Patients with mild biochemical abnormalities were excluded. RESULTS: The annual percentage of toxic liver injury ranged from 50% to 90% among acute hepatitis groups. Among the causes, prescribed drugs (group D) accounted for 55%, herbs or plant products (group H) for 42% and both accounted for 3%. Antibiotics and anti-inflammatory drugs were the most common agents (78%) among group D. The mean age of the patients was 43 and 70% of patients were female. Of the population, common symptoms were jaundice, weakness, fatigue, and nausea. Initial ALT and AST levels were 847 +/- 879 and 664 +/- 625 IU/L, and initial total bilirubin was 7.5 +/- 8.1 mg/dL. Acute toxic liver injury occurred after a mean of 32 days after first exposure. Liver injury resolved within a mean of 32 days. Hepatocellular, mixed, and cholestatic type was 45.2%, 32.3%, 22.5%, respectively. CONCLUSIONS: Recently, acute toxic liver injury has been the most common cause of acute hepatitis in Korea. Prescribed drugs and herbs or plant products are equally important etiologic agents of toxic liver injury. However, etiologic difference may not affect clinical courses or outcomes. A nationwide investigation of the hepatotoxicity of drugs, herbs or other plant products is required.