Korean J Med > Volume 78(4); 2010 > Article
The Korean Journal of Medicine 2010;78(4):457-465.
Clinical features of 28 acutely toxic hepatitis patients who ingested Dictamnus dasycarpus: A single center clinical experience
Jae Hoon Jung, Seok Hyun Kim, Kwang Hun Ko, Kyoung Hye Jung, Se Woong Hwang, Pyong Gohn Goh, Nam Hwan Park, Gwan Woo Nam, Jeong IL Kim, Hee Seok Moon, Eaum Seok Lee, Jae Kyu Sung, Byung Seok Lee, Heon Young Lee, Dae Young Kang
백선 복용 후 발생한 독성 간염 28예의 임상적 특징
정재훈, 김석현, 고광훈, 정경혜, 황세웅, 고평곤, 박남환, 남관우, 김정일, 문희석, 이엄석, 성재규, 이병석, 이헌영, 강대영
Abstract
Background/Aims: The aim of this study was to investigate the clinical features of acutely toxic hepatitis associated with ingesting Dictamnus dasycarpus (D. dasycarpus). Methods: Between January 2004 and July 2009, 28 patients were enrolled in this study. We reviewed the medical records retrospectively. Acutely toxic hepatitis associated with D. dasycarpus was diagnosed by a Roussel Uclaf Causality Assessment Method Values (RUCAM) score of 6 or above. All patients were tested for viral hepatitis A, B, C, cytomegalovirus, and Epstein-Barr virus. Other tests included anti-nuclear antibody, anti-mitochondrial antibody, and anti-smooth muscle antibody. Abdominal pelvic computed tomography was performed. Results: The incidence was female predominant (64% vs. 36%). The mean patient age was 53.0±11 years. The symptoms were jaundice (68%), fatigue (57%), nausea (43%), anorexia (43%), and abdominal pain (24%). The mean RUCAM score was 7.0±0.8. The biochemical patterns of hepatotoxicity were hepatocellular (n=23, 82%) and mixed types (n=5, 18%). Radiologic findings were as follows: normal findings (29%), lymphadenopathy (50%), edema of the gall bladder wall (46%), periportal edema (43%), splenomegaly (11%), fatty liver (11%), and ascites (7%). The mean hospitalization period was 21.6±11.6 days. The mean duration of recovery from hepatitis was 56.6±30.4 days, and all patients recovered completely from the toxic hepatitis. One patient who had severe jaundice developed a complication of pure red cell aplasia during the hospitalization period. Conclusions: The biochemical pattern of liver injury was hepatocellular predominant. Although the initial manifestations and clinical course were variable, all patients completely recovered with supportive care or steroid treatment. Toxic hepatitis was accompanied by pure red cell aplasia in one patient. (Korean J Med 78:457-465, 2010)
Key Words: Dictamnus dasycarpus; Toxic hepatitis; Pure red cell aplasia


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