Su Qian, Pan Jinjin, Zhang Li, Xia Lingling, Gao Yufeng, Li Jiabin
Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Pharmacol. 2022 Apr 20;13:862222. doi: 10.3389/fphar.2022.862222. eCollection 2022.
Drug-induced liver injury (DILI) caused by Chinese patent medicines is increasing in China. The incidence of invasive fungal infections (IFIs) is increasing due to the suppression of the immune function in greater numbers of patients. Invasive procedures such as deep vein catheterization and the use of glucocorticoids are also predisposing factors to IFIs. The clinical presentation of IFI in teenagers is often atypical, challenging to diagnose, difficult to treat, and associated with a high fatality rate. Herein, we report 2 teenagers with liver failure after receiving oral Chinese patent medicines. Case 1 was a 14-year-old boy who presented with subacute liver failure who had been administered a Chinese patent medicine that included acetaminophen. Administration of glucocorticoids and non-bioartificial liver treatment improved his condition. Subsequently, invasive pulmonary (IPA) was diagnosed and was successfully treated with voriconazole for 85 days. Case 2 was a 17-year-old girl who presented with acute liver failure after taking the Chinese patent medicine QubaiBabuqi tablets for vitiligo. Chest computed tomography (CT) revealed multiple pulmonary nodules with an intermittent low-grade fever, and she was diagnosed with IPA. She was initially treated with caspofungin (23 days) and then voriconazole (406 days) for 429 days. Her liver function returned to normal, and lung lesions were absorbed in 2 patients. At the same time, two to three histopathological examinations of the liver biopsy showed that the drug-induced autoimmune-like phenomena could be improved by glucocorticoid therapy. To the best of our knowledge, this is the first report of the successful treatment of 2 cases of liver failure (Child-Pugh class C) caused by Chinese patent medicines complicated with IPA in teenagers. Drug-induced autoimmune-like phenomena could be improved by glucocorticoid therapy.
在中国，中成药所致药物性肝损伤（DILI）的病例正在增加。由于大量患者免疫功能受到抑制，侵袭性真菌感染（IFI）的发病率也在上升。诸如深静脉插管等侵入性操作以及糖皮质激素的使用也是IFI的诱发因素。青少年IFI的临床表现通常不典型，诊断具有挑战性，治疗困难，且病死率高。在此，我们报告2例青少年在口服中成药后出现肝衰竭的病例。病例1是一名14岁男孩，表现为亚急性肝衰竭，曾服用一种含有对乙酰氨基酚的中成药。给予糖皮质激素和非生物人工肝治疗后病情好转。随后，诊断为侵袭性肺曲霉病（IPA），并成功使用伏立康唑治疗85天。病例2是一名17岁女孩，因服用治疗白癜风的中成药祛白巴布期片后出现急性肝衰竭。胸部计算机断层扫描（CT）显示多个肺结节，伴有间歇性低热，诊断为IPA。她最初接受卡泊芬净治疗（23天），然后使用伏立康唑治疗（406天），共治疗429天。她的肝功能恢复正常，肺部病变在2例患者中均被吸收。同时，肝活检进行两到三次组织病理学检查显示，糖皮质激素治疗可改善药物诱导的自身免疫样现象。据我们所知，这是首次成功治疗2例青少年因中成药并发IPA导致肝衰竭（Child-Pugh C级）的报告。糖皮质激素治疗可改善药物诱导的自身免疫样现象。
