The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

One case of fulminant hepatic failure related to Dictamnus dasycarpus

백선 복용 후 발생한 전격성 간부전 1예

An, So-Yun;Cheong, Jae-Youn;Kim, Soon-Sun;Lee, Da-Mi;Seok, Jae-Yeon;Kim, Young-Bae;Cho, Sung-Won
안소연;정재연;김순선;이다미;석재연;김영배;조성원

  • Published : 20100400
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Abstract

We report a case of fulminant hepatic failure related to ingesting Dictamnus dasycarpus. The patient had taken D. dasycarpus for 8 weeks after boiling down the root of D. dasycarpus in water, to promote health. The main symptoms and signs were general weakness and jaundice. Serology found no evidence of hepatitis A, B, or C infections. Imaging studies, including abdominal ultrasonography and abdominal computed tomography, did not reveal any bile duct structural abnormalities. Based on the RUCAM score (8 points), D. dasycarpus was the probable cause for the drug-induced liver injury. Despite meticulous monitoring and supportive care, the patient died by a progression to fulminant hepatic failure. This case indicates that D. dasycarpus can cause lethal outcomes by fulminant hepatic failure.

백선은 봉삼, 봉황삼이라고 불리는 것으로, 비교적 쉽게 구할 수 있고 한약재료나 민간요법에 많이 사용된다. 현재까지 국내에서 백선을 복용한 후 소수의 예에서 독성 간염을 일으킨 것으로 보고되었으나 이로 인한 전격성 간부전으로 사망한 예는 보고된 바 없었다. 저자 등은 57세 여자에서 백선의 뿌리를 달인 물을 마시고 독성 간염을 보였으며 광범위한 간세포의 괴사로 인한 간부전으로 진행하여 사망한 예를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Kane JA, Kane SP, Jain S. Hepatitis induced by traditional Chinese herbs: possible toxic components. Gut 36:146-147, 1995 https://doi.org/10.1136/gut.36.1.146
  2. McRae CA, Agarwal K, Mutimer D, Bassendine MF. Hepatitis associated with Chinese herbs. Eur J Gastroenterol Hepatol 14:559-562, 2002 https://doi.org/10.1097/00042737-200205000-00015
  3. Jang JS, Seo EG, Han C, Chae HB, Kim SJ, Lee JD, Wang JH. Four cases of toxic liver injury associated with Dictamnus dasycarpus. Korean J Hepatol 14:206-212, 2008 https://doi.org/10.3350/kjhep.2008.14.2.206
  4. Kim DJ. The assessment of toxic liver injury. Korean J Gastroenterol 53:5-14, 2009
  5. Sgro C, clinard F, Ouazir K, Chanay H, Allard C, Guilleminet C, Lenoir C, Lemoine A, Hillon P. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 36:451-455, 2002 https://doi.org/10.1053/jhep.2002.34857
  6. Lee JH, LeeHY, Koh KC, Lee JK, Rhee PL, Kim JJ, Paik SW, Rhee JC, Oh YR, Chi YJ. Drug induced liver disease caused by ingestion of Dictamnus dasycarpus. Korean J Gastroenterol 31:251-257, 1998
  7. Bissell DM, Gores GJ, Laskin DL, Hoofnagle JH. Drug-induced liver injury: mechanisms and test systems. Hepatology 33:1009- 1013, 2001 https://doi.org/10.1053/jhep.2001.23505
  8. Seeff LB. Herbal hepatotoxicity. Clin Liver Dis 11:577-596, 2007 https://doi.org/10.1016/j.cld.2007.06.005
  9. Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med 354:731-739, 2006 https://doi.org/10.1056/NEJMra052270
  10. Danan G, Benichou C. Causality assessment of adverse reactions to drugs-I: a novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol 46:1323-1330, 1993 https://doi.org/10.1016/0895-4356(93)90101-6