Basset Céline, Vadrot Jacqueline, Denis Jacques, Poupon Joël, Zafrani Elie Serge
Département de Pathologie, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France.
Liver Int. 2003 Apr;23(2):89-93. doi: 10.1034/j.1600-0676.2003.00806.x.
Hepatotoxicity, predominantly cholestatic, is a rare adverse effect of gold salt therapy, which usually completely resolves within a few months. We report the case of a female patient treated for rheumatoid arthritis, who had gold salt overdose, and in whom acute cholestatic hepatitis occurred three weeks after beginning of therapy. Evolution of gold concentration was followed in plasma and urine, as well as in cutaneous and liver dry tissue. Liver biopsy showed marked inflammatory changes of interlobular bile ducts that evolved towards ductopenia, which was responsible for prolonged cholestasis still present 15 months later. In addition, sialadenitis with sicca syndrome was noted six months after onset of the disease. The mechanism of hepatotoxicity was probably immunoallergic since liver lesions were associated with hypersensitivity syndrome including dermatitis and blood and tissue eosinophilia. This is the first report of gold salt hepatotoxicity with histological demonstration of cholangitis followed by ductopenia.
肝毒性，主要为胆汁淤积性，是金盐治疗罕见的不良反应，通常在数月内完全消退。我们报告一例类风湿关节炎女性患者，她金盐过量，在治疗开始三周后发生急性胆汁淤积性肝炎。对血浆、尿液以及皮肤和肝脏干组织中的金浓度变化进行了跟踪。肝活检显示小叶间胆管有明显炎症改变，并发展为胆管减少，这导致了15个月后仍存在的长期胆汁淤积。此外，疾病发作六个月后出现了伴有干燥综合征的涎腺炎。肝毒性机制可能为免疫过敏，因为肝脏病变与包括皮炎、血液及组织嗜酸性粒细胞增多在内的过敏综合征相关。这是首例有胆管炎组织学证据随后发展为胆管减少的金盐肝毒性报告。
