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2.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088684

ABSTRACT

El consumo ilícito de esteroides anabólicos androgénicos con fines estéticos ha aumentado en los últimos años y, aunque raro, es causa de hepatotoxicidad. Los casos con daño hepatocelular son más frecuentes, pero los colestásicos son más graves y pueden asociarse a falla renal. Salvo por la suspensión del fármaco, la hepatotoxicidad por anabólicos no tiene tratamiento específico. Se describe y discuten las historias clínicas de dos hombres jóvenes, deportistas aficionados que consultaron por ictericia y presentaron colestasis e insuficiencia renal. El reporte de casos, en patologías poco frecuentes, resulta fundamental para difundir y ampliar la información que ayude al clínico a considerar con firmeza este diagnóstico, incluso ante la falta de reconocimiento inicial del consumo por parte del paciente.


Illicit consumption of anabolic-androgenic steroids for aesthetic purposes has increased in recent years. Hepatocellular damage is more frequent, but cholestasis is more dangerous and may be associated with renal failure. The clinical records of two young men, amateur athletes who consulted for jaundice in the last year and denied its consumption at the beginning, are described. Except for the drug interruption, hepatotoxicity by anabolics has no specific treatment. Usually presented as cholestatic liver disease and renal failure, case reports are fundamental to characterize its clinical-evolutionary presentation. This may also allow clinicians to firmly consider diagnosis even when the patient denies consumption.


O uso ilícito de esteróides androgênicos anabólicos para fins estéticos tem aumentado nos últimos anos e, apesar de raro, é causa de hepatotoxicidade. Casos com dano hepatocelular são mais freqüentes, mas colestesia é mais grave e pode estar associada à insuficiência renal. Com exceção da suspensão do medicamento, a hepatotoxicidade anabólica não possui tratamento específico. As histórias clínicas de dois homens jovens, atletas amadores que consultaram para icterícia e apresentaram colestase e insuficiência renal, são descritos e discutidos. O relato de casos, em patologias pouco freqüentes, é fundamental para disseminar e ampliar as informações que auxiliam o clínico a considerar com firmeza esse diagnóstico antes mesmo do não reconhecimento inicial do consumo pelo paciente.


Subject(s)
Humans , Male , Adult , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/rehabilitation , Anabolic Agents/adverse effects , Androgens/adverse effects , Pruritus/chemically induced , Cholestasis/chemically induced , Renal Dialysis , Renal Insufficiency/chemically induced , Renal Insufficiency/therapy , Jaundice/chemically induced
3.
Braz. J. Pharm. Sci. (Online) ; 54(4): e17449, 2018. graf
Article in English | LILACS | ID: biblio-1001568

ABSTRACT

The aim of the present study is to illustrate the effects of swertiamarin (STM), a natural iridoid from herbal medicines, on hepatic inflammation induced by carbon tetrachloride (CCl4) in rats. Male Sprague Dawley rats were exposed to CCl4 with or without STM co-administration for 8 weeks. Our results revealed that STM administration (100 and 200 mg/kg b.w.) significantly attenuated inflammation in livers of CCl4-treated rats. STM remarkably reduced the production of interleukin-1ß (IL-1ß), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), macrophage inflammatory protein-1a (MIP-1α), and monocyte chemotactic protein-1 (MCP-1) in liver tissue of CCl4-treated rats. In addition, STM treatment downregulated connective tissue growth factor (CTGF) and ser307pIRS-1 expression, which was induced by CCl4 exposure. In the process of exploring the anti-inflammatory mechanisms of STM action, we demonstrated that STM significantly inhibited Toll-like receptor 4 (TLR4) and nuclear factor kappa B (NF-κB) p65 expression in the liver. In conclusion, these results suggested that the inhibition of CCl4-induced inflammation by STM was, at least in part, due to its regulation of the TLR4 /NF-κB signaling pathway


Subject(s)
Animals , Male , Rats , Carbon Tetrachloride/pharmacology , Toll-Like Receptor 4 , Chemical and Drug Induced Liver Injury/diagnosis , NF-kappa B , Gentianaceae/classification , Glycosides/adverse effects , Inflammation/drug therapy
4.
Gastroenterol. latinoam ; 29(3): 147-154, 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-1117304

ABSTRACT

Drug-induced liver injury (DILI) is a rare entity associated with high morbidity and mortality. It includes a broad spectrum of clinical patterns, from acute hepatitis to cirrhosis. Among the common associated drugs are antimicrobial like anti-TBC, antineoplastic, CNS agents and non-steroidal anti-inflammatory drugs. Establishing causality between DILI and a certain drug is a challenge. Some scoring systems have been evaluated, considering RUCAM score as the gold standard. We present the case of a 35-year-old woman with a history of a high-grade glioma treated with surgery and chemotherapy with lomustine, procarbazine and vincristine. She evolved with altered liver tests, predominantly cholestatic pattern, but asymptomatic. Etiologic study negative and abdominal imaging were normal. The liver biopsy was compatible with 40% ductopenia, without inflammatory elements. We consider DILI associated with the use of lomustine, with RUCAM score suggesting. After discontinuing chemotherapy and using ursodeoxycholic acid for the treatment of cholestasis there was an improvement in liver tests. There is limited evidence in the literature regarding hepatotoxicity associated with lomustine, mainly in experimental animal models. Cases of cholestatic hepatotoxicity have been described with the use of other similar nitrosureas. In relation to procarbazine and vincristine, DILI is reported mainly reversible and predominantly with hepatocellular pattern, not consistent with our case. We find it interesting to communicate with review of the literature about it.


El daño hepático inducido por drogas (DILI) es una entidad poco frecuente, con alta morbimortalidad asociada. Incluye un amplio espectro de patrones clínicos, desde hepatitis aguda a cirrosis. Dentro de los fármacos frecuentemente asociados se encuentran antibióticos como anti-TBC, agentes antineoplásicos, de acción en el SNC y anti-inflamatorios no esteroidales. Establecer una causalidad entre DILI y una determinada droga constituye un desafío. Para ello, se han evaluado diversos sistemas de puntuación, considerándose gold estándar el RUCAM score. Se presenta el caso de una mujer de 35 años de edad con antecedentes de glioma de alto grado operado y en quimioterapia con lomustina, procarbazina y vincristina. En su evolución presenta alteración de pruebas hepáticas de predominio colestásico de manera asintomática, con estudio etiológico causal negativo e imagenológico normal. La biopsia hepática fue compatible con ductopenia de 40% sin elementos inflamatorios. Se plantea DILI asociado al uso de lomustina con un score de RUCAM sugerente, decidiéndose interrumpir sus ciclos de quimioterapia e inicia tratamiento con ácido ursodesoxicólico, presentando mejoría progresiva de pruebas hepáticas. Existe evidencia limitada en la literatura en relación a hepatotoxicidad asociada a este fármaco, principalmente en modelos experimentales, y con el uso de otras nitrosureas similares se han descrito casos de hepatotoxicidad de predominio colestásico. En relación con procarbazina y vincristina existen reportes de DILI principalmente reversible y con patrón de predominio hepatocelular, lo que no es concordante con nuestro caso, por lo cual nos parece de interés comunicarlo con revisión de la literatura al respecto.


Subject(s)
Humans , Female , Adult , Cholestasis/chemically induced , Antineoplastic Agents, Alkylating/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Lomustine/adverse effects , Cholestasis/diagnosis , Chemical and Drug Induced Liver Injury/diagnosis
5.
Ann. hepatol ; 16(3): 442-450, May.-Jun. 2017. tab
Article in English | LILACS | ID: biblio-887257

ABSTRACT

ABSTRACT Introduction and aims. Drug-induced liver injury (DILI) is rare; however, it is one of the important causes of acute liver failure which results in significant morbidity or mortality. Material and methods. Patients with suspected DILI were enrolled based on predefined criteria and followed up for at least 6 months or until normalization of liver tests. Causality assessment was done by applying the Roussel Uclaf Causality Assessment Method model. Results. We collected data from 82 individuals diagnosed with DILI at our hospital from 2014 through 2015 (41 men; median age, 38 years). The most commonly implicated drugs were antitubercular therapy (ATT) (49%), antiepileptic drugs (12%), complementary and alternative medicine (CAM) in 10%, antiretroviral drugs (9%) and non-steroidal anti-inflammatory drugs (6%). 8 out of 13 deaths were liver related. Also, liver related mortality was significantly higher for ATT DILI (17.5%) vs. those without (2.4%) (P = 0.02). There was no significant difference in overall as well as liver related mortality in hepatocellular, cholestatic or mixed pattern of injury. Laboratory parameters at one week after discontinuation of drug predicted mortality better than those at the time of DILI recognition. On multivariate logistic regression analysis, jaundice, encephalopathy, MELD (Model for end stage liver disease) score and alkaline phosphatase at one week, independently predicted mortality. Conclusion. DILI results in significant overall mortality (15.85%). ATT, anti-epileptic drugs, CAM and antiretroviral drugs are leading causes of DILI in India. Presence of jaundice, encephalopathy, MELD score and alkaline phosphatase at one week are independent predictors of mortality.(AU)


Subject(s)
Humans , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/etiology , Antitubercular Agents/adverse effects , Evaluation Studies as Topic , India
6.
Ann. hepatol ; 16(2): 308-311, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-887237

ABSTRACT

ABSTRACT A 75-year old male patient had been regularly visiting our hospital for the management of his type 2 diabetes mellitus since he was diagnosed at age 64 years. When he developed hypoglycemic episodes with sulfonylurea, ipragliflozin (50 mg/day) was started to replace the sulfonylurea therapy. However, 49 days after starting ipragliflozin, his AST increased from 13 to 622 U/L, ALT increased from 9 to 266 U/L, ALP increased from 239 to 752 U/L, and γ-GTP increased from 19 to 176 U/L. ZTT was 3.5 U, TTT was 0.4 U, and total bilirubin was 0.7 mg/dL. IgM hepatitis A antibody, hepatitis B antigen, hepatitis C virus antibody, IgM CMV antibody, and IgM EB VCA antibody were negative, whereas a lymphocyte transformation test for ipragliflozin was positive. Abdominal CT scan showed mild fatty liver but no sign of nodular lesions. Following admission to our hospital, he received liver supportive therapy with the discontinuation of ipragliflozin therapy. He was discharged from the hospital 18 days later with AST and ALT levels reduced to 20 U/L and 13 U/L, respectively. Based on the clinical presentation of this patient, it is highly important to monitor liver function along with other possible clinical complications (e.g., dehydration, ketosis, and urinary tract infection) associated with SGLT2 inhibitor therapy.


Subject(s)
Humans , Male , Aged , Lymphocyte Activation/drug effects , Diabetes Mellitus, Type 2/drug therapy , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/immunology , Glucosides/adverse effects , Hypoglycemic Agents/adverse effects , Thiophenes/adverse effects , Predictive Value of Tests , Risk Factors , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/blood , Chemical and Drug Induced Liver Injury/therapy , Liver Function Tests
7.
Gut and Liver ; : 27-36, 2016.
Article in English | WPRIM | ID: wpr-111621

ABSTRACT

Drug-induced liver injury (DILI) remains a significant clinical challenge and is the leading cause of acute liver failure in most countries. An aging population that uses more medications, a constant influx of newly developed drugs and a growing risk from unfamiliar herbal and dietary supplements will make DILI an increasing part of clinical practice. Currently, the most effective strategy for disease management is rapid identification, withholding the inciting agents, supportive care and having a firm understanding of the expected natural history. There are resources available to aid the clinician, including a new online "textbook" as well as causality assessment tools, but a heightened awareness of risk and the disease's varying phenotypes and good history-taking remain cornerstones to diagnosis. Looking ahead, growing registries of cases, pharmacoepidemiology studies and translational research into the mechanisms of injury may produce better diagnostic tools, markers for risk and disease, and prevention and therapeutics.


Subject(s)
Age Factors , Anti-Infective Agents/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anticonvulsants/adverse effects , Biopsy , Dietary Supplements/adverse effects , Chemical and Drug Induced Liver Injury/diagnosis , Drugs, Chinese Herbal/adverse effects , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Incidence , Liver/pathology , Liver Function Tests , Risk Factors , Tumor Necrosis Factor-alpha/antagonists & inhibitors
8.
Article in English | WPRIM | ID: wpr-56141

ABSTRACT

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.


Subject(s)
Abdomen/diagnostic imaging , Chemical and Drug Induced Liver Injury/diagnosis , Female , Humans , Iodine Radioisotopes/chemistry , Lymph Nodes/pathology , Lymphatic Metastasis , Middle Aged , Prednisolone/therapeutic use , Thyroid Neoplasms/drug therapy , Thyroidectomy , Thyroxine/therapeutic use , Ultrasonography
9.
Article in English | WPRIM | ID: wpr-54508

ABSTRACT

Levocetirizine is a second-generation nonsedative antihistaminic agent that has been demonstrated to be safe and effective for treating allergic disease. There was only one case report of levocetirizine-induced liver toxicity, but a liver biopsy was not performed. In this article, we present the first case of levocetirizine-induced liver injury with histologic findings. A 48-year-old man was hospitalized with jaundice and generalized pruritus that had developed after 2 months of therapy with levocetirizine for prurigo nodularis. Laboratory findings revealed acute hepatitis with cholestasis. A liver biopsy demonstrated portal inflammation and hepatitis with apoptotic hepatocytes. The patient fully recovered 3 weeks after withdrawing levocetirizine. Although levocetirizine is safe and effective, physicians should be aware of its potential hepatotoxicity.


Subject(s)
Cetirizine/adverse effects , Chemical and Drug Induced Liver Injury/diagnosis , Histamine H1 Antagonists, Non-Sedating/adverse effects , Humans , Hypersensitivity/drug therapy , Jaundice/etiology , Liver/pathology , Male , Middle Aged , Pruritus/etiology
10.
Rev. Soc. Bras. Med. Trop ; 48(5): 633-635, Sept.-Oct. 2015. tab, graf
Article in English | LILACS | ID: lil-763323

ABSTRACT

ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.


Subject(s)
Aged , Animals , Humans , Male , Bothrops , Crotalid Venoms/poisoning , Chemical and Drug Induced Liver Injury/diagnosis , Hematoma/chemically induced , Hematoma/diagnosis , Tomography, X-Ray Computed
11.
Article in Korean | WPRIM | ID: wpr-223599

ABSTRACT

A 61-year-old male patient was admitted because of unexplained abdominal pain and anemia. His past medical history was unremarkable except for having taken herbal medicine to treat facial palsy two months ago. The result of health examination performed about a month ago showed increased serum aspartate and alanine aminotransferase level, and he was diagnosed with toxic hepatitis by herbal medicine. When the patient presented to the outpatient department three weeks ago, follow-up liver function test results showed improvement but he complained of abdominal pain. Despite extensive blood chemistry tests and computed tomography, the cause of pain could not be found. After much deliberation, serum lead level and herbal medicines analysis was performed based on the fact that he took herbal medicine two months ago, and he could finally be diagnosed with lead poisoning. Since the serum lead level was high enough to be indicated for lead chelating therapy, conservative management was given. When a patient with toxic hepatitis due to herbal medication presents with abdominal pain, the possibility of lead poisoning should always be taken into consideration.


Subject(s)
Acute Disease , Alanine Transaminase/analysis , Aspartate Aminotransferases/analysis , Chemical and Drug Induced Liver Injury/diagnosis , Hemoglobins/analysis , Humans , Lead/analysis , Lead Poisoning , Liver/enzymology , Liver Function Tests , Male , Middle Aged , Plants, Medicinal/chemistry
12.
Article in English | WPRIM | ID: wpr-113899

ABSTRACT

Aloe is one of the leading products used in phytomedicine. Several cases of aloe-induced toxic hepatitis have been reported in recent years. However, its toxicology has not yet been systematically described in the literature. A 21-year-old female patient was admitted to our hospital with acute hepatitis after taking an aloe vera preparation for four weeks. Her history, clinical manifestation, laboratory findings, and histological findings all led to the diagnosis of aloe vera-induced toxic hepatitis. We report herein on a case of acute toxic hepatitis induced by aloe vera.


Subject(s)
Adult , Aged , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Aloe/chemistry , Chemical and Drug Induced Liver Injury/diagnosis , Female , Humans , Liver/pathology , Male , Middle Aged , Plant Extracts/adverse effects , Splenomegaly/diagnosis , Tomography, X-Ray Computed , Young Adult
13.
Article in Korean | WPRIM | ID: wpr-171340

ABSTRACT

In Korea, the use of herbal remedies is a common cause of drug-induced liver injury. However, the occurrence of both acute pancreatitis and acute hepatitis after taking herbal remedies has rarely been reported. Herein, we report a case of concurrent acute pancreatitis and acute hepatitis associated with Ceramium kondoi ingestion. A 58-year-old woman was diagnosed with advanced gastric cancer 7 months ago. Total gastrectomy and adjuvant chemotherapy was performed without complications. The patient had been well until recently, when she presented with severe abdominal pain after ingestion of Ceramium kondoi for 4 weeks. The laboratory findings demonstrated elevated liver enzymes and lipase, and abdominal computed tomography revealed pancreas swelling with fat infiltration. The diagnosis was made based on the diagnostic criteria for drug induced pancreatitis and the Russel Uclaf Causality Assessment Method scale for drug-induced liver injury. After cessation of Ceramium kondoi, she showed clinical and biochemical improvement.


Subject(s)
Abdominal Pain/etiology , Acute Disease , Chemical and Drug Induced Liver Injury/diagnosis , Female , Humans , Lipase/metabolism , Liver/drug effects , Middle Aged , Pancreas/drug effects , Pancreatitis/chemically induced , Plant Extracts/chemistry , Rhodophyta/chemistry , Tomography, X-Ray Computed
14.
West Indian med. j ; 61(9): 932-936, Dec. 2012. ilus
Article in English | LILACS | ID: lil-694370

ABSTRACT

The use of new antiretroviral drugs in HIV infection is particularly important in patients with intolerance or resistance to other antiretroviral agents. Raltegravir and maraviroc represent new, important resources in salvage regimens. A reduced grade of liver fibro-steatosis after a combination of raltegravir and maraviroc (second-line) has not been studied and the mechanism by which these new drug classes induced a marked reduction of grade of liver diseases is currently unknown. In the present case report, nested in an ongoing multicentre observational study on the use of new antiretroviral inhibitors in heavy treatment-experienced HIV patients, we evaluated the correlation between a "short therapeutic regimen" raltegravir, maraviroc and fosamprenavir and liver diseases. The aim of this report is to describe the use of a three-drug regimen based on two novel-class antiretroviral agents (raltegravir and maraviroc) plus the protease inhibitor fosamprenavir, in an experienced HIV-infected patient with chronic progressive hepatitis C complicated by liver fibrosis; an overwhelming increased serum creatine kinase level occurred during treatment, and is probably related to integrase inhibitor administration. At present no information is available regarding this correlation.


El uso de nuevos medicamentos antiretrovirales para la infección por VIH es particularmente importante en los pacientes con intolerancia o resistencia a otros agentes antiretrovirales. Raltegravir (RTV) y maraviroc (MRV) representan nuevos e importantes recursos en las terapias de salvamento. Un grado reducido de fibroesteatosis hepática después de una combinación de raltegravir y maraviroc (terapia de segunda línea) no ha sido estudiado, y el mecanismo por el cual estas nuevas clases de droga indujeron una marcada reducción de grado de las enfermedades hepáticas se desconoce hasta el momento. Como parte de la realización en curso de un estudio observacional multicentro acerca del uso de nuevos inhibidores antiretrovirales en pacientes de VIH altamente experimentados en el tratamiento, en el presente reporte de caso se evalúa la correlación entre un "régimen terapéutico corto" (raltegravir, maraviroc y fosamprenavir) y las enfermedades del hígado. El objetivo de este reporte es describir el uso de un régimen de tres medicamentos - basado en dos agentes antiretrovirales de nuevo tipo (raltegravir y maraviroc) además del fosamprenavir inhibidor de la proteasa - en un paciente de VIH experimentado. El paciente también sufre de hepatitis C evolutiva, progresiva, crónica, complicada por fibrosis hepática. Durante el tratamiento, se produjo un aumento extraordinario del nivel de creatina quinasa sérica, el cual probablemente esta relacionado con la administración del inhibidor de la integrasa. Actualmente no hay información disponible con respecto a esta correlación.


Subject(s)
Adult , Humans , Male , Carbamates/adverse effects , Cardiomyopathies/drug therapy , Creatine Kinase/blood , Cyclohexanes/adverse effects , Chemical and Drug Induced Liver Injury/diagnosis , Fatty Liver/chemically induced , HIV Fusion Inhibitors/adverse effects , HIV Infections/drug therapy , HIV Integrase Inhibitors/adverse effects , HIV Protease Inhibitors/adverse effects , Hepatitis C, Chronic/drug therapy , Liver Cirrhosis/chemically induced , Organophosphates/adverse effects , Pyrrolidinones/adverse effects , Sulfonamides/adverse effects , Triazoles/adverse effects , Carbamates/therapeutic use , Cyclohexanes/therapeutic use , Drug Substitution , Drug Therapy, Combination , Fatty Liver/diagnosis , HIV Fusion Inhibitors/therapeutic use , HIV Integrase Inhibitors/therapeutic use , HIV Protease Inhibitors/therapeutic use , Liver Cirrhosis/diagnosis , Organophosphates/therapeutic use , Pyrrolidinones/therapeutic use , Sulfonamides/therapeutic use , Triazoles/therapeutic use
15.
Article in English | WPRIM | ID: wpr-101276

ABSTRACT

BACKGROUND/AIMS: Accurate diagnosis of drug-induced liver injury (DILI) is difficult without considering the possibility of underlying diseases, especially autoimmune hepatitis (AIH). We investigated the clinical patterns in patients with a history of medication, liver-function abnormalities, and in whom liver biopsy was conducted, focusing on accompaniment by AIH. METHODS: The clinical, serologic, and histologic findings of 29 patients were compared and analyzed. The patients were aged 46.2+/-12.8 years (mean+/-SD), and 72.4% of patient were female. The most common symptom and causal drug were jaundice (58.6%) and herbal medications (55.2%), respectively. RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase, total bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase levels were 662.2+/-574.8 U/L, 905.4+/-794.9 U/L, 12.9+/-10.8 mg/dL, 195.8+/-123.3 U/L, and 255.3+/-280.8 U/L, respectively. According to serologic and histologic findings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited significantly higher AST levels (537.1+/-519.1 vs. 1043.3+/-600.5 U/L), globulin levels (2.7+/-0.4 vs. 3.3+/-0.5 g/dL), and prothrombin time (12.9+/-2.4 vs. 15.2+/-3.9 s; P<0.05). Antinuclear antibody was positive in 7 of 21 cases of DILI and all 8 cases of AIH (P=0.002). The simplified AIH score was 3.7+/-0.9 in the DILI group and 6.5+/-0.9 in the AIH group (P<0.001). CONCLUSIONS: Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of AIH should be considered.


Subject(s)
Adult , Alanine Transaminase/blood , Antibodies, Antinuclear/blood , Aspartate Aminotransferases/blood , Biopsy , Chemical and Drug Induced Liver Injury/diagnosis , Female , Globulins/analysis , Hepatitis, Autoimmune/diagnosis , Herbal Medicine , Humans , Jaundice/etiology , Male , Middle Aged , Prothrombin Time
16.
Article in English | WPRIM | ID: wpr-210181

ABSTRACT

Liver injury due to prescription and nonprescription medications is a growing medical, scientific, and public health problem. Worldwide, the estimated annual incidence rate of drug-induced liver injury (DILI) is 13.9-24.0 per 100,000 inhabitants. DILI is one of the leading causes of acute liver failure in the US. In Korea, the annual extrapolated incidence of cases hospitalized at university hospital is 12/100,000 persons/year. Most cases of DILI are the result of idiosyncratic metabolic responses or unexpected reactions to medication. There is marked geographic variation in relevant agents; antibiotics, anticonvulsants, and psychotropic drugs are the most common offending agents in the West, whereas in Asia, 'herbs' and 'health foods or dietary supplements' are more common. Different medical circumstances also cause discrepancy in definition and classification of DILI between West and Asia. In the concern of causality assessment, the application of the Roussel Uclaf Causality Assessment Method (RUCAM) scale frequently undercounts the cases caused by 'herbs' due to a lack of previous information and incompatible time criteria. Therefore, a more objective and reproducible tool that could be used for the diagnosis of DILI caused by 'herbs' is needed in Asia. In addition, a reporting system similar to the Drug-Induced Liver Injury Network (DILIN) in the US should be established as soon as possible in Asia.


Subject(s)
Dietary Supplements/adverse effects , Chemical and Drug Induced Liver Injury/diagnosis , Herbal Medicine , Humans , Liver Failure, Acute/pathology , Prognosis , Risk Factors , Severity of Illness Index
18.
Article in English | WPRIM | ID: wpr-194174

ABSTRACT

Amoxicillin, an antibiotic that is widely prescribed for various infections, is associated with a very low rate of drug-induced liver injury; hepatitis and cholestasis are rare complications. Here we present a case of a 39-year-old woman who was diagnosed with abdominal actinomycosis and received amoxicillin treatment. The patient displayed hepatocellular and bile-duct injury, in addition to elevated levels of liver enzymes. The patient was diagnosed with amoxicillin-induced cholestatic hepatitis. When amoxicillin was discontinued, the patient's symptoms improved and her liver enzyme levels reduced to near to the normal range.


Subject(s)
Actinomycosis/drug therapy , Adult , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Amoxicillin/adverse effects , Anti-Bacterial Agents/adverse effects , Aspartate Aminotransferases/blood , Cholestasis/chemically induced , Chemical and Drug Induced Liver Injury/diagnosis , Female , Humans , Liver/enzymology
19.
Rev. méd. Maule ; 26(2): 103-109, sept. 2010. tab
Article in Spanish | LILACS | ID: lil-574221

ABSTRACT

La Hepatotoxicidad por drogas se define como una lesión hepática asociada a deterioro de la función de éste órgano, secundaria a exposición a una droga u otro agente no infeccioso. Es un cuadro infrecuente, pero puede determinar graves lesiones hepáticas y una mortalidad considerable si no se detecta a tiempo. Es labor del clínico mantener un alto Índice de sospecha al enfrentarse a un paciente con alteraciones hepáticas de reciente comienzo y uso concomitante de medicamentos. En el presente articulo se expone el caso clínico de un paciente masculino, 48 años de edad, con Depresión Severa en tratamiento con Sertralina, Clonazepam, Risperidona, Lamotrigna y Acido Valproico. Ingresó al Hospital de Talca con diagnostico de Síndrome Colestásico cuyo estudio demostró serología para VHB y VHC negativa y ecotomografía abdominal normal. Presentó buena respuesta clínica y de laboratorio a la suspensión de las drogas. El cuadro fue compatible con Hepatotoxicidad por drogas.


Subject(s)
Humans , Male , Middle Aged , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/therapy , Chemical and Drug Induced Liver Injury/physiopathology , Risk Factors
20.
Article in Korean | WPRIM | ID: wpr-14481

ABSTRACT

Toxic hepatitis has been reported as a major cause of acute hepatitis, but its potential induction by herbal remedies and/or health foods is usually neglected. We experienced a case of toxic hepatitis associated with Polygoni multiflori, a Chinese herb commonly known as Ho-Shou-Wu. A 54-year-old woman consumed Ho-Shou-Wu for 1 month, after which she experienced fatigue and overall weakness. A diagnosis of toxic hepatitis was made based on her clinical history, the findings for viral markers and other laboratory data, and ultrasonography. Her condition improved considerably after she stopped taking Ho-Shou-Wu. However, she resumed taking Ho-Shou-Wu immediately after discharge from hospital, which aggravated her symptoms and liver function. She was immediately readmitted and stopped taking Ho-Shou-Wu. Her relapse into hepatitis immediate after resuming consumption of the herb is strongly indicative of the validity of Koch's postulate in this case.


Subject(s)
Chemical and Drug Induced Liver Injury/diagnosis , Female , Humans , Middle Aged , Plant Extracts/toxicity , Polygonum/toxicity
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