Division of Gastroenterology and Hepatology, Liver Program, University of North Carolina, Chapel Hill, North Carolina 27599-7584, USA.
Clin Gastroenterol Hepatol. 2010 Jul;8(7):635-7. doi: 10.1016/j.cgh.2010.03.020. Epub 2010 Apr 2.
Diagnosing drug-induced liver injury (DILI) relies primarily on history taking. We report 4 cases in which DILI was missed or the drug was misidentified when physicians relied solely on patient history. We reviewed 27 cases referred with possible DILI from August 1, 2009, to February 1, 2010. Four patients seemed to be reliable historians, but their cases were greatly clarified by a call to their pharmacist. One subject, who forgot a new medication, underwent an unfruitful evaluation including surgery. Another patient had acetaminophen toxicity that was missed because she grossly underreported her pain medication use. The third and fourth patients forgot taking amoxicillin/clavulanate, so other agents mistakenly were implicated. Roussel Uclaf Causality Assessment Method scores were 8 (probable) or 9 (highly probable) for all 4 cases. Without pharmacy input, DILI was missed in 2 cases and the wrong agent was implicated twice. Reviewing pharmacy records can be crucial for patients and DILI research. We recommend calling the pharmacist directly for increased liver enzyme levels of unclear source or suspected DILI regardless of patient history.
诊断药物性肝损伤（DILI）主要依赖于病史采集。我们报告了 4 例病例，当医生仅依赖于患者病史时，这些病例被误诊或药物被错误识别。我们回顾了 2009 年 8 月 1 日至 2010 年 2 月 1 日期间转诊的 27 例疑似 DILI 病例。这 4 名患者似乎都是可靠的病史提供者，但通过与他们的药剂师通话，他们的病例得到了很大的澄清。一名患者忘记了一种新的药物，尽管进行了包括手术在内的无效评估。另一名患者因严重低估了自己的止痛药物使用量而导致对乙酰氨基酚中毒被漏诊。第三和第四位患者忘记服用阿莫西林/克拉维酸钾，因此错误地涉及到了其他药物。所有 4 例病例的 Roussel Uclaf 因果关系评估方法评分均为 8（可能）或 9（高度可能）。如果没有药剂师的意见，2 例病例被误诊，而且错误地涉及到了两种药物。对于不明原因或疑似 DILI 的肝酶水平升高的患者，无论其病史如何，我们建议直接与药剂师联系，这对患者和 DILI 研究都至关重要。
