Service d'hépato-gastroentérologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France.
Clin Res Hepatol Gastroenterol. 2013 Nov;37(5):e109-13. doi: 10.1016/j.clinre.2013.06.003. Epub 2013 Jul 30.
Severe acute hepatotoxicity is a well known complication following the ingestion of ecstasy (3,4-methylenedioxymethamphetamine [MDMA] ecstasy). Hepatic dysfunction has also been reported after acute cocaine intoxication. However, chronic hepatitis after prolonged use of ecstasy and/or cocaine has rarely been reported.
We report the case of a 27-year-old woman hospitalized with edema, ascites and severe liver failure (prothrombin rate 33%), following the use of ecstasy and cocaine over the previous 9 months. Clinical, biological, radiological and pathology findings were recorded at admission and over 8 years' follow-up.
Liver biopsy showed architectural distortion caused by bridging fibrosis, proliferation of cholangioles, and lesions of active interface hepatitis. Other causes of acute and chronic liver disease were excluded. Magnetic resonance imaging showed marked liver fibrosis. After withdrawal of both substances clinical examination and liver function tests progressively normalized. Long-term monitoring with magnetic resonance imaging showed progressive regression of fibrosis.
Use of ecstasy and cocaine may cause chronic hepatitis leading to marked liver fibrosis, which may regress after withdrawal of both substances.
已知服用摇头丸（3,4-亚甲二氧基甲基苯丙胺[MDMA]摇头丸）会导致严重的急性肝毒性。急性可卡因中毒后也有报道称会出现肝功能障碍。然而，长期使用摇头丸和/或可卡因后慢性肝炎的情况很少见。
我们报告了一例 27 岁女性的病例，她在过去 9 个月内使用摇头丸和可卡因后出现水肿、腹水和严重肝功能衰竭（凝血酶原率 33%）。入院时和 8 年随访期间记录了临床、生物学、影像学和病理学发现。
肝活检显示桥接纤维化引起的结构扭曲、胆小管增生和活跃界面肝炎病变。排除了其他急性和慢性肝病的原因。磁共振成像显示明显的肝纤维化。停用两种物质后，临床检查和肝功能试验逐渐正常化。磁共振成像的长期监测显示纤维化逐渐消退。
使用摇头丸和可卡因可能导致慢性肝炎，导致明显的肝纤维化，停用两种物质后可能会消退。
