Paiva L A, Wright P J, Koff R S
Department of Medicine, Framingham Union Hospital, Massachusetts.
Am J Gastroenterol. 1992 Jul;87(7):891-3.
Nitrofurantoin-induced hepatic injury has been established unequivocally as an entity by rechallenge experiences. We reviewed 12 previously reported cases in which rechallenge was described. The longest reported interval between initial injury and rechallenge-provoked injury was 4 yr. We report a 56-yr-old woman who experienced severe hepatocellular injury with brief low-dose administration of nitrofurantoin 17 yr after an initial hepatitis-like illness associated with ingestion of the drug. Despite a temporal relationship to nitrofurantoin administration and histologic features compatible with drug-induced hepatitis, the initial bout of hepatitis had been termed "infectious." Our case appears remarkable for the long interval between initial injury and rechallenge-induced injury. The severity of the hepatic injury seen on rechallenge underscores the concept that the inadvertent rechallenge can be dangerous. Failure to identify the first bout of hepatitis as nitrofurantoin-related, and failure to inform the patient about the possible relationship to nitrofurantoin, raises important risk-management concerns, because hepatic memory of nitrofurantoin hypersensitivity appears to be of long duration.
通过再激发试验，呋喃妥因所致肝损伤已被明确认定为一种独立的病症。我们回顾了12例先前报道的描述了再激发试验的病例。初始损伤与再激发诱发损伤之间报道的最长间隔为4年。我们报告了一名56岁女性，在最初因摄入该药物出现类似肝炎的疾病17年后，短期小剂量服用呋喃妥因后发生了严重的肝细胞损伤。尽管与呋喃妥因给药存在时间关联且组织学特征符合药物性肝炎，但最初那次肝炎发作被诊断为“感染性”。我们的病例中初始损伤与再激发诱发损伤之间的间隔时间之长显得很突出。再激发时所见肝损伤的严重程度凸显了无意中进行再激发可能很危险这一概念。未能将首次肝炎发作认定为与呋喃妥因相关，以及未告知患者其与呋喃妥因可能的关系，引发了重要的风险管理问题，因为呋喃妥因超敏反应的肝脏记忆似乎持续时间很长。
