Binder C, Lang W
Medizinische Klinik II, Krankenhaus des Landkreises Peine, Hannover.
Dtsch Med Wochenschr. 1993 Oct 22;118(42):1515-9. doi: 10.1055/s-2008-1059479.
A 74-year-old woman developed weakness, lack of appetite and abdominal swelling 7 months after starting treatment with carbimazole (10 mg/d for 10 weeks) and, subsequently, radioiodine for hyperthyroidism. Physical examination revealed generalized oedema and ascites. Computed tomography showed a liver of normal size but infiltrated by nodules up to 4 cm in diameter. Erythrocyte sedimentation rate was raised and there were abnormal concentrations of haemoglobin, total proteins, liver enzymes and creatinine, as well as decreased platelet and white cell counts. Thyroid function was normal. Viral and autoimmune diseases were largely excluded. Liver biopsy showed a severe, highly active hepatitis with parenchymal necroses, large-drop fatty infiltration and intralobular granuloma-like inflammatory reactions, as well as lympho-histiocytic inflammation of the portal areas. The most likely cause was the carbimazole treatment. In addition to symptomatic treatment she received prednisone (1 mg/kg), because an allergic diathesis could not be excluded. But she died of hepatic failure 6 weeks after admission.
一名74岁女性在开始使用卡比马唑（10毫克/天，共10周）及随后使用放射性碘治疗甲状腺功能亢进7个月后，出现乏力、食欲不振和腹部肿胀。体格检查发现全身水肿和腹水。计算机断层扫描显示肝脏大小正常，但有直径达4厘米的结节浸润。红细胞沉降率升高，血红蛋白、总蛋白、肝酶和肌酐浓度异常，血小板和白细胞计数降低。甲状腺功能正常。基本排除了病毒性和自身免疫性疾病。肝活检显示为严重的、高度活跃的肝炎，伴有实质坏死、大滴脂肪浸润和小叶内肉芽肿样炎症反应，以及门管区的淋巴细胞-组织细胞炎症。最可能的病因是卡比马唑治疗。除了对症治疗外，由于不能排除过敏体质，她还接受了泼尼松（1毫克/千克）治疗。但她在入院6周后死于肝衰竭。
