Ni Y H, Chang M H, Wu M Z
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
J Formos Med Assoc. 1991 Feb;90(2):202-5.
Diphenylhydantoin-induced hepatitis and mononucleosis are uncommon in children. The occurrence of these two diseases in the same individual, with progression to hepatic failure is rare and has not been reported in infants. This report represents a 6-month-old male infant who developed an infectious mononucleosis-like syndrome and hepatic failure 16 days after diphenylhydantoin administration. He took this anticonvulsant for controlling seizures after a head injury. Fever, skin rash, hepatosplenomegaly, lymphadenopathy, and atypical lymphocytosis led to the initial diagnosis of infectious mononucleosis. However, negative heterophil antibody did not support the diagnosis. Jaundice ensued in the following course and became more and more profound. Meanwhile, physical examination showed shrinking in liver size. Negative virology studies, including Epstein-Barr virus, cytomegalovirus, and hepatitis B virus, excluded them as causative agents. The patient lapsed into a stage I hepatic coma, but gradually recovered clinically and biochemically after eight successive exchange transfusions and supportive care. Two liver biopsies were performed 20 and 50 days after the onset of disease, respectively. Remarkable hepatic parenchymal loss, cholestasis, and fatty change were found on histologic examination of the first biopsy specimen, and portal fibrosis was noted on the second.
苯妥英钠所致肝炎和单核细胞增多症在儿童中并不常见。这两种疾病在同一个体中发生，并进展为肝衰竭的情况罕见，且在婴儿中尚未见报道。本报告介绍了一名6个月大的男婴，在服用苯妥英钠16天后出现了传染性单核细胞增多症样综合征和肝衰竭。他因头部受伤后服用这种抗惊厥药来控制癫痫发作。发热、皮疹、肝脾肿大、淋巴结病和非典型淋巴细胞增多导致最初诊断为传染性单核细胞增多症。然而，嗜异性抗体阴性不支持该诊断。在接下来的病程中出现黄疸，且越来越严重。同时，体格检查显示肝脏大小缩小。包括EB病毒、巨细胞病毒和乙型肝炎病毒在内的病毒学研究结果均为阴性，排除了这些病毒作为致病因素。患者陷入I期肝昏迷，但在连续8次换血和支持治疗后临床和生化指标逐渐恢复。分别在疾病发作后20天和50天进行了两次肝脏活检。在第一次活检标本的组织学检查中发现显著的肝实质丧失、胆汁淤积和脂肪变性，第二次活检则发现门静脉纤维化。
