Piccolo Paola, Gentile Silvia, Alegiani Filippo, Angelico Mario
Tor Vergata University, Hepaotology Unit, via Montpellier, Rome, 00135, Italy.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.08.2008.0761. Epub 2009 Apr 14.
A 61-year-old woman with chronic hepatitis C received peginterferon α 180 μg/week, and obtained undetectable qualitative hepatitis C virus (HCV) RNA (lower limit of detection 50 IU/ml) after 8 weeks of treatment. Shortly thereafter aminotransferase values greatly increased (>20 × upper limit of normal) and did not decline after treatment suspension. The patient admitted taking St John's wort (Hypericum perforatum) for depressed mood, recommended by a friend, during the preceding 6 weeks. Liver function tests continued to worsen and international normalised ratio (INR) prolongation developed; the patient was hospitalised. Test for antinuclear antibody was positive (1:320) and treatment with methylprednisolone was started; bilirubin and aminotransferase levels slowly declined, though a new flare occurred when steroids were tapered. After 6 months of prednisone treatment, the liver function tests returned to baseline levels. The combination of peginterferon α and St John's wort resulted in a severe acute hepatitis in this patient. Patients should be advised of this potential toxic effect of this herbal remedy.
一名61岁的慢性丙型肝炎女性患者接受聚乙二醇干扰素α治疗，剂量为每周180μg，治疗8周后丙型肝炎病毒（HCV）RNA定性检测不到（检测下限为50IU/ml）。此后不久，转氨酶值大幅升高（>正常上限的20倍），停药后也未下降。患者承认在之前6周内按照朋友的建议服用圣约翰草（贯叶连翘）以缓解情绪低落。肝功能检查持续恶化，国际标准化比值（INR）延长；患者住院治疗。抗核抗体检测呈阳性（1:320），开始使用甲泼尼龙治疗；胆红素和转氨酶水平缓慢下降，但在逐渐减少类固醇剂量时出现了新的病情发作。泼尼松治疗6个月后，肝功能检查恢复到基线水平。聚乙二醇干扰素α与圣约翰草合用导致该患者发生严重急性肝炎。应告知患者这种草药疗法的这种潜在毒性作用。
