Namn Yunseok, Schneider Yecheskel, Cui Isabelle H, Jesudian Arun
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
Department of Pathology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
Case Reports Hepatol. 2017;2017:3864236. doi: 10.1155/2017/3864236. Epub 2017 Jan 26.
Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Unites States and accounts for 10% of acute hepatitis cases. We report the only known case of diphenhydramine-induced acute liver injury in the absence of concomitant medications. A 28-year-old man with history of 13/14-chromosomal translocation presented with fevers, vomiting, and jaundice. Aspartate-aminotransferase and alanine-aminotransferase levels peaked above 20,000 IU/L and 5,000 IU/L, respectively. He developed coagulopathy but without altered mental status. Patient reported taking up to 400 mg diphenhydramine nightly, without concomitant acetaminophen, for insomnia. He denied taking other medications, supplements, antibiotics, and herbals. A thorough workup of liver injury ruled out viral hepatitis (including A, B, C, and E), autoimmune, toxic, ischemic, and metabolic etiologies including Wilson's disease. A liver biopsy was consistent with DILI without evidence of iron or copper deposition. Diphenhydramine was determined to be the likely culprit. This is the first reported case of diphenhydramine-induced liver injury without concomitant use of acetaminophen.
药物性肝损伤（DILI）是美国急性肝衰竭最常见的病因，占急性肝炎病例的10%。我们报告了唯一一例已知的在未同时使用其他药物情况下由苯海拉明引起的急性肝损伤病例。一名有13/14号染色体易位病史的28岁男性出现发热、呕吐和黄疸。天冬氨酸转氨酶和丙氨酸转氨酶水平分别高达20000 IU/L和5000 IU/L以上。他出现了凝血功能障碍，但精神状态未改变。患者报告因失眠每晚服用高达400毫克苯海拉明，未同时服用对乙酰氨基酚。他否认服用其他药物、补充剂、抗生素和草药。对肝损伤进行的全面检查排除了病毒性肝炎（包括甲型、乙型、丙型和戊型）、自身免疫性、中毒性、缺血性以及包括威尔逊病在内的代谢性病因。肝活检结果符合药物性肝损伤，无铁或铜沉积证据。确定苯海拉明可能是罪魁祸首。这是首例报告为由苯海拉明引起的肝损伤且未同时使用对乙酰氨基酚的病例。
