Hinrichsen H, Lüttges J, Klöppel G, Fölsch U R, Schmidt W E
First Dept. of Medicine, Christian-Albrechts-University, Kiel, Germany.
Scand J Gastroenterol. 2001 Jul;36(7):780-3. doi: 10.1080/003655201300192076.
Coumarin anticoagulants are known to cause hepatotoxicity, but only a few cases have been reported. Coumarins are usually administered following cardiovascular surgery and the differential diagnosis is post-transfusion hepatitis.
We report the case of a 46-year-old woman who presented with jaundice, elevated liver function tests, positive antinuclear and smooth muscle antibodies following prodromal signs of fatigue and nausea. The patient had been treated with phenprocoumon for 5 months in order to prevent thromboembolism after two strokes assumed to be due to an open foramen ovale and an aneurysmatic atrial septum.
There was no evidence of viral or other causes of hepatitis. The patient rapidly developed subacute liver failure with encephalopathy and phenprocoumon treatment was stopped. With intensive care support, as well as high-dose prednisolone treatment, she recovered. Owing to positive antinuclear and smooth muscle antibodies, the initial diagnosis 'acute autoimmune hepatitis with liver failure was made.
The lack of hypergammaglobulinaemia and the rapid recurrence of hepatitis following re-exposure to phenprocoumon led to the final diagnosis of phenprocoumon-induced idiosyncratic drug allergic hepatitis with secondary autoimmune phenomena.
已知香豆素类抗凝剂会导致肝毒性，但仅有少数病例报道。香豆素类药物通常在心血管手术后使用，鉴别诊断为输血后肝炎。
我们报告了一名46岁女性的病例，该患者在出现疲劳和恶心等前驱症状后，出现黄疸、肝功能检查指标升高、抗核抗体和平滑肌抗体阳性。该患者因假定由卵圆孔未闭和动脉瘤性房间隔导致的两次中风后，接受苯丙香豆素治疗5个月以预防血栓栓塞。
没有证据表明存在病毒性或其他肝炎病因。患者迅速发展为伴有脑病的亚急性肝衰竭，苯丙香豆素治疗被停止。在重症监护支持以及大剂量泼尼松龙治疗下，她康复了。由于抗核抗体和平滑肌抗体阳性，最初诊断为“伴有肝衰竭的急性自身免疫性肝炎”。
缺乏高球蛋白血症以及再次接触苯丙香豆素后肝炎迅速复发，最终诊断为苯丙香豆素诱导的特异质性药物过敏性肝炎伴继发性自身免疫现象。
