Benson G D, Anderson P K, Combes B, Ishak K G
Department of Medicine, University of Medicine and Dentistry of New Jersey-Rutgers Medical School, Camden 08103.
Dig Dis Sci. 1988 Feb;33(2):240-6. doi: 10.1007/BF01535739.
Two patients developed prolonged and progressive jaundice associated with ketoconazole-induced hepatic injury although the drug was discontinued before or shortly after the onset of symptoms of hepatic toxicity. One patient, who had been jaundiced for eight weeks and was not improving, showed prompt clinical improvement and progressive resolution of jaundice following therapy with prednisolone. Liver biopsy before therapy showed marked cholestasis in all acinar zones and moderately severe fibrosis in the space of Disse. The other patient, who was less severely jaundiced, showed spontaneous resolution although he remained jaundiced for 11 weeks. Liver biopsy performed three weeks after onset of symptoms showed a moderate degree of cholestasis in acinar zone 3 and collagen deposition about the terminal hepatic venules and within the space of Disse. These cases are reported because of the unique clinical course, documentation of the morphologic features, and experience with corticosteroid therapy.
两名患者出现了与酮康唑诱导的肝损伤相关的持续性和进行性黄疸，尽管在肝毒性症状出现之前或之后不久就停用了该药物。一名患者黄疸持续了八周且病情没有改善，在接受泼尼松龙治疗后临床症状迅速改善，黄疸逐渐消退。治疗前的肝活检显示所有腺泡区均有明显胆汁淤积，狄氏间隙有中度严重纤维化。另一名患者黄疸程度较轻，尽管黄疸持续了11周，但仍自行消退。症状出现三周后进行的肝活检显示3区腺泡有中度胆汁淤积，肝终末小静脉周围和狄氏间隙内有胶原沉积。报告这些病例是因为其独特的临床病程、形态学特征记录以及皮质类固醇治疗经验。
