Ishii M, Miyazaki Y, Yamamoto T, Miura M, Ueno Y, Takahashi T, Toyota T
Third Department of Internal Medicine, Tohoku University School of Medicine, Japan.
Liver. 1993 Aug;13(4):227-31. doi: 10.1111/j.1600-0676.1993.tb00635.x.
A 50-year-old woman suffered from a diffuse skin rash, high fever and jaundice immediately after a second injection of glutathion and Stronger Neo-minophagen C which contains glycyrrhizin. Liver biopsy performed 11 months after the onset showed mild spotty hepatocyte necrosis, marked cholestasis in parenchyma, and some lymphocyte infiltration in the portal area. Interlobular bile ducts had undergone vacuolar degeneration or were absent in some portal tracts. In her hospital course, unremitting jaundice persisted and biliary cirrhosis developed with signs of portal hypertension; she died from liver failure 26 months after the onset. A liver specimen at her death revealed that most of the interlobular bile ducts had vanished. Based on the clinical course and pathology, drug-induced ductopenia, possibly due to an adverse reaction to glycyrrhizin, is the most likely diagnosis. While drug-related biliary cirrhosis is rarely fatal, this case presented an unusually rapid course of fatal biliary cirrhosis.
一名50岁女性在第二次注射谷胱甘肽和含有甘草酸的强力新诺明C后，立即出现弥漫性皮疹、高热和黄疸。发病11个月后进行的肝活检显示轻度散在肝细胞坏死、实质内明显胆汁淤积以及门管区一些淋巴细胞浸润。小叶间胆管出现空泡变性，或在一些门管区缺失。在她的住院过程中，黄疸持续不退，并发展为胆汁性肝硬化，伴有门静脉高压体征；发病26个月后死于肝衰竭。她死亡时的肝脏标本显示，大部分小叶间胆管已经消失。根据临床病程和病理，药物性胆管减少症（可能是对甘草酸的不良反应所致）是最可能的诊断。虽然药物相关性胆汁性肝硬化很少致命，但该病例呈现出异常迅速的致命性胆汁性肝硬化病程。
