The patient was a 14 year-old female. She had been hospitalized repeatedly since infancy for suspected tonsillitis. During this time, she experienced high fever for about a week once a month. In her school years, she often had a recurrent fever with cervical adenitis, with only a mild inflammatory reaction. We diagnosed her symptom as one of a periodic fever syndrome, triggered by the frequent administered antipyretic drugs for fevers of unknown origin (FUO). We also suspected that there was liver tension, based on her abdominal and back examination, and we prescribed yokukansan. After a 3-month course of yokukansan, she no longer experienced these fevers. Most case reports of FUO describe the use of bupleurum root drugs and tonic formulas as treatment. Although yokukansan has traditionally been used for FUO in older texts, to our knowledge, there are no reports on such use clinically. In the present patient's case, the yokukansan may have reduced or eliminated some type of trigger for the fevers, or it may have affected the regulation of cytokines.

Orthopedic symptoms are not rare in palmoplantar pustulosis, but standardized treatments have not yet been established.Here we report a case of palmoplantar pustulosis followed by joint pain that was successfully treated with the Kampo formulation saikokeishito. The patient was a 44-year-old Japanese man. He was suffering from pustules on the soles of his feet due to palmoplantar pustulosis, and joint pain of the sternoclavicular area, hip and lumbo-sacral area, which had not been controlled with diclofenac sodium suppositories. We prescribed saikokeishito for 1 month, and he felt less joint pain and experienced less pustulosis. After that, he suffered from an upper respiratory tract infection, and he again developed plantar pustulosis. We added kikyo (Platycodon grandiflorum root) to treat the sore throat, and his symptoms almost disappeared following this treatment. No author has reported a patient with palmoplantar pustulosis accompanied by joint pain who was treated with saikokeishito. The results experienced in this case suggest that saikokeishito could be a useful formulation for the treatment of palmoplantar pustulosis accompanied by joint pain.

Case reports of drug-induced liver injury caused by Kampo medicines are on the rise, but most of them are noted for related symptoms such as jaundice. Usually, severe liver injury is detected by chance upon routine medical checkup. Recently, we noted 3 cases of suspected drug-induced liver injury caused by orengedokuto, saikokeishikankyoto and bofutsushosan. In these 3 cases, maximum ALT was under 100 IU/l and no symptoms related to liver injury were observed. Early detection by blood test was useful, and appropriate treatment quickly improved and normalized the abnormal values associated with liver injury. We should always be alert for drug-induced liver injury caused by Kampo medicines, especially when prescribing formulations that include Scutellariae Radix. We also emphasize the importance of scheduling blood tests when prescribing these formulations.