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A Case of Drug-Induced Autoimmune Hepatitis after Glucosamine Ingestion

글루코사민 복용 후 발생한 약물 유발성 자가면역성 간염

  • Kwon, Seong Soon (Department of Internal Medicine, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine) ;
  • Wee, Jee Wan (Department of Internal Medicine, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine) ;
  • Park, Jung Wan (Department of Internal Medicine, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine) ;
  • Yoon, Seug Yun (Department of Internal Medicine, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine) ;
  • Jeong, Soung Won (Department of Internal Medicine, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine) ;
  • Jang, Jae Young (Department of Internal Medicine, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine) ;
  • Jin, Yoon Mi (Department of Pathology, Soonchunghyang University Seoul Hospital, Soonchunghyang University College of Medicine)
  • 권성순 (순천향대학교 의과대학 서울병원 내과) ;
  • 위지완 (순천향대학교 의과대학 서울병원 내과) ;
  • 박정완 (순천향대학교 의과대학 서울병원 내과) ;
  • 윤석윤 (순천향대학교 의과대학 서울병원 내과) ;
  • 정승원 (순천향대학교 의과대학 서울병원 내과) ;
  • 장재영 (순천향대학교 의과대학 서울병원 내과) ;
  • 진윤미 (순천향대학교 의과대학 서울병원 병리학과)
  • Received : 2013.01.29
  • Accepted : 2013.05.03
  • Published : 2013.11.01

Abstract

Herbal remedies and health foods are widely used, and their side effects have been reported. Glucosamine is a naturally occurring amino-monosaccharide and a safe health food; rarely, however, it can cause cholestatic and hepatocellular hepatitis. We describe a case of drug-induced autoimmune hepatitis after ingestion of glucosamine. A middle-aged woman who had no history of liver disease complained of jaundice after taking glucosamine. The diagnosis of drug-induced acute autoimmune hepatitis was made using the Roussel Uclaf Causality Assessment Method score based on the patient's history and laboratory data, and percutaneous liver biopsy. After supportive care and administering prednisolone and azathiprine, the patient showed rapid improvement in clinical symptoms and laboratory findings.

글루코사민은 흔하게 사용되며 각광받는 건강 보조식품 중 하나로 항산화 효과 등이 보고되어 있으나 독성, 특히 간염에 대해서는 아직 잘 알려지지 않았다. 저자들은 글루코사민 섭취 후 간독성이 발생한 67세 여자 환자를 경험하였다. 상기 식품을 한 달 이상 섭취 후 약제 유발성 급성 자가면역 간염이 발생하였으며 간손상이 발생할 만한 다른 원인은 관찰되지 않았다. 12주간의 보존적인 치료와 자가면역 간염에 대한 치료(prednisolone과 azathioprine의 병합요법) 후 증상과 생화학적 이상 소견이 호전되었다.

Keywords

References

  1. Dahmer S, Schiller RM. Glucosamine. Am Fam Physician 2008;78:471-476.
  2. Tapadinhas MJ, Rivera IC, Bignamini AA. Oral glucosamine sulphate in the management of arthrosis: report on a multicentre open investigation in Portugal. Pharmatherapeutica 1982;3:157-168.
  3. Monauni T, Zenti MG, Cretti A, et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes 2000;49:926-935. https://doi.org/10.2337/diabetes.49.6.926
  4. Smith A, Dillon J. Acute liver injury associated with the use of herbal preparations containing glucosamine: three case studies. BMJ Case Rep 2009:2009. pii: bcr02.2009.1603.
  5. Von Felden J, Montani M, Kessebohm K, Stickel F. Drug-induced acute liver injury mimicking autoimmune hepatitis after intake of dietary supplements containing glucosamine and chondroitin sulfate. Int J Clin Pharmacol Ther 2013;51:219-223. https://doi.org/10.5414/CP201835
  6. Seo JC, Jeon WJ, Park SS, et al. Clinical experience of 48 acute toxic hepatitis patients. Korean J Hepatol 2006;12: 74-81.
  7. Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med 2006;354:731-739. https://doi.org/10.1056/NEJMra052270
  8. Krawitt EL. Autoimmune hepatitis. N Engl J Med 2006; 354:54-66. https://doi.org/10.1056/NEJMra050408
  9. Czaja AJ. Drug-induced autoimmune-like hepatitis. Dig Dis Sci 2011;56:958-976. https://doi.org/10.1007/s10620-011-1611-4
  10. Bjornsson E, Talwalkar J, Treeprasertsuk S, et al. Druginduced autoimmune hepatitis: clinical characteristics and prognosis. Hepatology 2010;51:2040-2048. https://doi.org/10.1002/hep.23588