No abstract available.
Humans ; Hepatitis, Toxic/*diagnosis/*etiology ; Acute Disease

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.
Acute Disease ; Adult ; English Abstract ; Female ; Hepatitis, Toxic/*diagnosis/etiology ; Humans ; Male ; Middle Aged

Liver injury due to prescription and nonprescription medications is a growing medical, scientific and public health problem. Drug-induced liver injury (DILI) is the single most common reason for regulatory actions, including failure of approval, removal from the marketplace and restriction of prescription. Worldwide, the estimated annual incidence rate of DILI is 13.9-24.0 per 100,000 inhabitants. At the same time, there is increasing concern about the potential risk for hepatotoxicity from complementary and alternative medicines (CAM) including herbal products because they are unregulated and not standardized with regard to their contents. Determining hepatotoxicity remains a major challenge in clinical practice due to a lack of reliable markers. The RUCAM/CIOMS scale have been proposed to establish a causal relationship between offending drug and liver injury. The efforts of Drug-Induced Liver Injury Network (DILIN, USA) directed toward the development of an abridged instrument in evaluating suspected drug-induced hepatotoxicity were presented at the National Institute of Health (NIH) Workshop, titled Drug-induced liver injury: Standardization of nomenclature and causality assessment, December, 2008. The main contents of the presentations and discussions at the NIH workshop are introduced in this article. This fine-tuned operations of RUCAM/CIOMS scale would enable a more confident assessment of causality and facilitate the collection of bona fide cases of drug-induced hepatotoxicity in Korea. Several demanding tasks for the near future in Korea are also proposed at the end.
Alanine Transaminase/blood ; Complementary Therapies ; Guidelines as Topic ; Hepatitis, Toxic/*diagnosis ; Herb-Drug Interactions ; Humans ; Risk Factors ; Severity of Illness Index

BACKGROUND/AIMS: There are no pathognomonic features of autoimmune hepatitis (AIH). Its diagnosis requires the exclusion of various other conditions. The aim of this study was to validate indirectly the International Autoimmune Hepatitis Group (IAHG) scoring system in diagnosing AIH. METHODS: Twenty-six patients with Type 1 AIH and female patients with chronic hepatitis B (n=34), chronic hepatitis C (n=25), or toxic hepatitis (n=13) were evaluated according to 9 categories of pretreatment minimum required parameters proposed by IAHG. Aggregate scores of AIH to those of non-AIH groups, which were assessed before and after extracting the proportions of etiologic factors, were also compared and evaluated. RESULTS: While aggregate scores of non-AIH groups, before extracting the proportions of etiologic factors, were 5.2+/-1.8, 5.6+/-1.1, and 7.4+/-1.2 in that order, those of AIH groups were 12.8+/-1.7. These were significantly higher than those of non-AIH groups (p<0.01). All patients in AIH groups and only 1 patient in a non-AIH group showed aggregate scores of more than 10. Aggregate scores after extracting the proportions of etiologic factors were more than 4 in all, except 2, patients. These should have been consistent with 10 if there were no etiologic factors in non-AIH groups. CONCLUSION: The IAHG scoring system might have a relatively excessive importance to the scores of categories excluding distinct etiologies from AIH. It might be difficult to differentiate AIH from chronic liver diseases of indistinct cause based on the IAHG scoring system.
Adult ; Aged ; Autoimmune Diseases/*classification/diagnosis ; English Abstract ; Female ; Hepatitis/*classification/diagnosis/immunology ; Hepatitis B, Chronic/classification/diagnosis ; Hepatitis C, Chronic/classification/diagnosis ; Hepatitis, Toxic/classification/diagnosis ; Human ; Korea ; Male ; Middle Aged

Orlistat(Xenical(R), Roche) is considered a safe and effective drug to treat obesity by reduced absorption of 30% digested fat. To date, no serious adverse effects affecting the liver have been published except a case of subacute hepatic failure leading to liver transplantation in a young women with moderate obesity treated with orlistat. We report a case of acute cholestatic hepatitis in a young woman with moderate obesity treated with orlistat: a 33-year-old female admitted for the evaluation of jaundice. Abdominal ultrasonography, ERCP, routine chemistry, viral markers, and a fine needle biopsy of liver were performed. Microscopic findings of the liver biopsy specimen were compatible with acute cholestatic hepatitis. After steroid therapy, liver function was improved.
Acute Disease ; Adult ; Anti-Obesity Agents/*adverse effects ; Cholestasis/*chemically induced/diagnosis ; English Abstract ; Female ; Hepatitis, Toxic/*diagnosis/etiology ; Human ; Lactones/*adverse effects ; Lipase/antagonists & inhibitors

BACKGROUND/AIMS: Although many individual cases of toxic hepatitis have been reported in Korea, there are few comprehensive systematic studies on acute toxic hepatitis. The first aim of this study is to investigate the frequency and clinical characteristics of acute toxic hepatitis patients. The second aim of this study is to investigate the efficacy of steroid therapy for immunoallergic idiosyncrasy. METHODS: Between March 1998 and March 2004 forty eight patients were included in this study. The medical records were reviewed retrospectively. Acute toxic hepatitis was diagnosed by score of more than 3 in RUCAM criteria. All the patients were tested for hepatitis A, B and C. Other tests included antibodies to CMV and EBV, ANA, AMA and SMA. RESULTS: Seventy-three percent of the patients were female and the mean age of the patients was 47. Twenty cases of acute toxic hepatitis (42%) were related to prescribed medications. The other causes were herbs (35%) and traditional therapeutic preparations (23%). Common symptoms were jaundice (35%), fatigue (10%), fever (9%) and abdominal pain (9%). The biochemical pattern of hepatotoxicity was divided into three groups: hepatocellular (81%), mixed (13%), and cholestatic types (6%). Three patients who have prolonged and severe jaundice were classified into immunoallergic idiosyncrasy based upon clinical and histologic findings. Prednisolone was prescribed in all three cases whose bilirubin levels had been higher than 15 mg/dL for at least 7 days. Jaundice and the laboratory findings rapidly improved within 8 days since the treatment began. CONCLUSIONS: In a demographic point of view, most patients of acute toxic hepatitis were middle aged women. Jaundice was the most commonly observed symptom. Prescribed drugs were the most common cause of acute toxic hepatitis. Although most cases of toxic hepatitis will recover with supportive care after cessation of the causative agent, steroid treatment may be helpful for the patients with severe jaundice patients who have immunoallergic idiosyncrasy.
Prednisolone/therapeutic use ; Middle Aged ; Male ; Jaundice/drug therapy/etiology ; Humans ; *Hepatitis, Toxic/diagnosis/drug therapy/etiology ; Glucocorticoids/therapeutic use ; Female ; Adult ; Acute Disease

We report four cases of toxic hepatitis that occurred after taking a decoction made by boiling down the root of Dictamnus dasycarpus. The four patients had a median age of 60 years, common symptoms of jaundice and general weakness, and stated that they had not consumed alcohol for at least 5 years. The markers of hepatitis A, B, and C were all negative in the patients. Abdominal ultrasonography revealed common bile ducts with normal diameters. Two of the cases were a mother and daughter, and the other two were sporadic. All of them had consumed a decoction made by boiling down the root of Dictamnus dasycarpus five or six times daily until several days before admission. Dictamnus dasycarpus induced liver injury presenting with a benign course lasting less than 1 month after cessation of the causative agent. We suggest that this natural product can cause acute hepatitis in rural areas.
Acute Disease ; Aged ; Dictamnus/*adverse effects ; Female ; Hepatitis, Toxic/*diagnosis/etiology/ultrasonography ; Humans ; Liver Function Tests ; Male ; Middle Aged ; Plant Roots/*adverse effects

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.
Albendazole/*adverse effects ; Antiprotozoal Agents/*adverse effects ; Eosinophils/metabolism ; Glucose/metabolism ; Hepatitis, Toxic/*diagnosis ; Humans ; Liver/drug effects ; Liver Function Tests ; Male ; Middle Aged ; Necrosis

Ticlopidine inhibits platelet aggregation and provides beneficial secondary prevention of cerebrovascular and coronary artery disease. Frequently reported adverse effects of ticlopidine include diarrhea, nausea, and rash. However, to our knowledge, there are only a few published reports of the simultaneous occurrence of cholestatic hepatitis and pure red cell aplasia. Here we report a patient with simultaneous severe cholestatic hepatitis and pure red cell aplasia associated with ticlopidine. Although these adverse effects are rare, periodic hematological and liver function tests are recommended after starting ticlopidine.
Acute Disease ; Cholestasis/*chemically induced/diagnosis/etiology ; Female ; Hepatitis, Toxic/*diagnosis/pathology ; Humans ; Liver Function Tests ; Middle Aged ; Platelet Aggregation Inhibitors/*adverse effects ; Red-Cell Aplasia, Pure/*chemically induced/diagnosis/pathology ; Ticlopidine/*adverse effects

BACKGROUNDS/AIMS: Toxic hepatitis has recently been discovered to be a major cause of acute hepatitis. We studied the clinical features and prognosis of patients diagnosed with toxic hepatitis at a single institution. METHODS: A retrospective analysis was performed using medical records of 159 cases of toxic hepatitis that were diagnosed from March 2003 to March 2008. Patients were selected based on a RUCAM score of 4 or above. RESULTS: The incidence was higher in women (n=97) than in men (n=62). The age (mean+/-SD) of the patients was 51+/-15 years . The major causes of the disease included the use of Korean traditional therapeutic preparations (34.0%), herbal medicines (41.5%), and drugs prescribed by a physician (23.9%). At the time of admission, jaundice was the most common symptom (41.5%), and the results of a liver serum battery were as follows: aspartate aminotransferase, 729.4+/-877.0 IU/L; alanine aminotransferase, 857.1+/-683.0 IU/L; total bilirubin, 6.4+/-6.5 mg/dL; and alkaline phosphatase, 209.8+/-130.0 IU/L. The hospitalization period was 10.0+/-9.5 days, and the duration of recovery from liver injury was 31.0+/-29.5 days. The factors associated with the hospitalization period included the presence of anorexia and the serum levels of albumin and bilirubin at the time of admission (P<0.05). A high serum bilirubin level and a history of alcohol ingestion were associated with a delayed recovery (Plt;0.05). The sex, age, BMI, and duration of medication were not significantly related to the hospitalization and recovery periods. CONCLUSIONS: The main cause of acute toxic hepatitis in the current study was the use of herbal medicines. The severity of liver injury at the time of admission was a major factor significantly associated with the hospitalization and recovery periods.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking ; Bilirubin/blood ; Drugs, Chinese Herbal ; Female ; Hepatitis, Toxic/*diagnosis/epidemiology/etiology ; Humans ; Length of Stay ; Male ; Medical Records ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index