Pariente E A, Maitre F, Marchand J P
Gastroenterol Clin Biol. 1986 Mar;10(3):255-8.
The authors report the case of a 63 year-old woman who developed high-grade fever with chills, nausea, diarrhea, severe pain in the right hypochondrium, and jaundice after one month's treatment with 300 mg of hydroquinidine hydrochloride daily. Serum bilirubin and aminotransferases were slightly increased, while alkaline phosphatases and gamma-glutamyl-transpeptidase serum activities were markedly raised. Histological examination of a liver specimen obtained by the transvenous route showed numerous epithelioid granulomas with giant cell formation and eosinophils in hepatic lobules and portal tracts. Symptoms disappeared three days after withdrawal of the drug, but hepatomegaly and a mild increase in serum gamma-glutamyl-transpeptidase persisted more than eighteen months. Quinidine-induced hepatitis is almost always associated with fever, and, in one-third of the cases, with a pseudo-cholangitis picture. Extrahepatic hypersensitivity manifestations are often present. Histological examination of the liver shows granulomatous or cytolytic hepatitis. Withdrawal of the drug is rapidly followed by a favorable outcome; readministration causes immediate relapse; progression to chronic liver disease has never been reported previously.
作者报告了一例63岁女性的病例，该患者在每日服用300毫克盐酸氢奎尼丁治疗一个月后，出现高热伴寒战、恶心、腹泻、右季肋部剧痛及黄疸。血清胆红素和转氨酶略有升高，而碱性磷酸酶和γ-谷氨酰转肽酶的血清活性显著升高。经静脉途径获取的肝脏标本组织学检查显示，肝小叶和门管区有大量上皮样肉芽肿形成，伴有巨细胞和嗜酸性粒细胞。停药三天后症状消失，但肝肿大和血清γ-谷氨酰转肽酶轻度升高持续了超过18个月。奎尼丁诱发的肝炎几乎总是伴有发热，三分之一的病例伴有假性胆管炎表现。常出现肝外过敏表现。肝脏组织学检查显示为肉芽肿性或细胞溶解性肝炎。停药后迅速出现良好转归；再次用药会立即复发；此前从未有进展为慢性肝病的报道。
