Pitre Tyler, Mah Jasmine, Vertes Jaclyn, Rebello Rosario, Zhu Julie
Michael G. DeGroote School of Medicine (Waterloo Regional Campus), McMaster University, Hamilton, Canada.
Faculty of Medicine, Dalhousie University, Halifax, Canada.
BMC Gastroenterol. 2019 Nov 27;19(1):199. doi: 10.1186/s12876-019-1122-x.
Drug induced liver injury (DILI) is an important cause of acute liver injury and accounts for approximately 10% of all cases of acute hepatitis. Both prescription and natural health products (NHPs) have been implicated in DILI. There is a dearth of studies on NHPs induced liver injury.
A previously healthy 37-year-old female presented with subacute hepatitis, in the context of a previous admission to a separate institution, months prior for undiagnosed acute hepatitis. Importantly, she had disclosed taking complex regiments of natural health products (NHPs) for months. Her only other medication was rivaroxaban for her homozygous Factor V Leiden deficiency. She had an extensive work up for causes of acute and unresolving hepatitis. She discontinued several but not all of her NHPs after her initial presentation for acute hepatitis at the first institution and continued taking NHPs until shortly after admission to our institution. The predominant pathological features were that of drug induced liver injury, although an abnormal amount of copper was noted in the core liver biopsies. However, Wilson's disease was ruled out with normal serum ceruloplasmin and 24-urine copper. After 2 months of stopping all the NHPs, our patient improved significantly since discharge, although there is evidence of fibrosis on ultrasound at last available follow up.
NHPs are a well-established but poorly understood etiology of DILI. The situation is exacerbated by the unregulated and unpredictable nature of many of the potential hepatotoxic effects of these agents, especially in cases of multiple potential toxic agents. This highlights the importance of acquiring a clear history of all medications regardless of prescription status.
药物性肝损伤（DILI）是急性肝损伤的重要原因，约占所有急性肝炎病例的10%。处方药和天然健康产品（NHPs）都与DILI有关。关于NHPs所致肝损伤的研究较少。
一名37岁既往健康的女性出现亚急性肝炎，数月前曾因未确诊的急性肝炎入住另一家机构。重要的是，她透露已服用复合天然健康产品数月。她唯一的其他药物是用于治疗纯合子因子V莱顿缺乏症的利伐沙班。她针对急性和持续性肝炎的病因进行了全面检查。在最初因急性肝炎在第一家机构就诊后，她停用了几种但并非所有的NHPs，并继续服用NHPs，直到入住我们机构后不久。主要病理特征为药物性肝损伤，尽管在肝组织活检核心部位发现铜含量异常。然而，血清铜蓝蛋白和24小时尿铜正常，可排除威尔逊病。停用所有NHPs 2个月后，我们的患者自出院后明显好转，尽管在最后一次随访的超声检查中有纤维化的证据。
NHPs是DILI的一个既定但了解不足的病因。这些药物许多潜在肝毒性作用的不受监管和不可预测的性质加剧了这种情况，尤其是在存在多种潜在毒性药物的情况下。这凸显了获取所有药物（无论是否为处方药）明确用药史的重要性。
