• 대한한의학회지
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• 제25권3호
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• pp.78-89
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• 2004

Background : A report published by the National Institute of Toxicological Research (NITR) in January 2004 about toxic hepatitis in Korea contained the result of analysis on 55 cases of severe toxic hepatitis from 7 university hospitals for 8 months. NITR claimed that the extrapolated annual frequency of severe toxic hepatitis in Korea was 1904 cases per year. They also claimed that the most frequent etiology of severe toxic hepatitis were herbal medications and similar plant preparations (61.7%), contrasted with traditional therapeutic preparations and healthy foods (29.1%). I have investigated that report to be certain of the result because it is a very important subject for public health and society in Korea. Results : The NITR report has too many problems to have faith in its results. They include the following: 1. The report uses only 55 cases to estimate annual prevalence rate of severe toxic hepatitis in Korea. 2. There was a large regional preponderancy in the NITR report (2 cases in Seoul from a population of 10.17 million, 19 cases in Gwangju from a population of 1.4 million) 3. There was another preponderancy that selected much fewer cases caused by western medication (9.1%) than other reasons. 4. The NITR report used a modified scale than that officially recognized to diagnose toxic hepatitis. 5. There was a mistake using the scale to adapt the right indications. 6. They collected cases before beginning the study, although it was a prospective study. There was also not any questionnaire or other materials concerned with alcohol, drugs, or history of past liver disease. Conclusions : NITR is one of the important official arms of the government of Korea. Nevertheless, there is a severe problem in validity because of selection bias, uncertain accuracy, and insufficiency of raw materials in the report. Therefore it seems incorrect to generalize the results of the report and there is a lack of confidence in it as a national study publishing by the NITR.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제15권2호
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• pp.111-116
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• 2012

Toxic hepatitis is a rare but devastating disease in children. Herbs are widely used in oriental medicine to treat various symptoms in Korea, however, several herbs have been reported to induce liver injury. We report a case of toxic hepatitis induced by Hovenia dulcis in a 3-year-old boy. He complained of nausea, abdominal discomfort, and jaundice. The patient had consumed water boiled with hovenia dulcis for about 1 year prior to presentation. A diagnosis of toxic hepatitis was made based on his history, laboratory data, viral markers, ultrasonography, and biopsied liver tissue. We administered supportive management for acute fulminant hepatitis but his symptoms and liver function progressed. He was transferred to another hospital for further evaluation and consideration for liver transplantation. Because acute liver failure due to herbs or dietary supplement taken for a long time is often fetal, it is important to make early diagnosis and stop taking the drug as soon as drug induced liver injury is suspected.

• 대한임상독성학회지
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• 제6권2호
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• pp.110-116
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• 2008

Purpose: Acute toxic hepatitis is a common cause of acute liver failure (ALF). We investigated the causes, clinical manifestation, and outcomes of ALF patients who underwent liver transplantation due to acute toxic hepatitis caused by herbal medicines and preparations. Methods: Between January 1992 and May 2008, we retrospectively reviewed the medical records of 24 patients who were transplanted due to acute toxic hepatitis caused by herbal medicines and preparations. We applied the RUCAM score to patients with acute toxic hepatitis and assessed the relationship between herbal preparations and liver injury. We studied the patients' medication history, liver function tests, and clinical outcomes. Results: The type of liver injury was divided into three groups: hepatocellular type, 14 patients (58.3%); cholestatic type, 4 patients (16.7%); and mixed type, 6 patients (25%). Polygonum multiflorum Thunberg (3 cases) was the most common cause of acute toxic hepatitis, followed by Acanthopanax senticosus (2 cases), pumpkin juice (2 cases), Dictamnus dasycarpus Turcz (2 cases), Hovenia dulcis (1 case), Phellinus linteus (1 case), and Artemisia capillaries (1 case). One year survival after liver transplantation was 76%. Conclusion: We identified the herbal preparations leading to acute liver failure. Many patients consider herbal remedies to be completely free of unwanted side effects. However, we found that many herbal products have biological activities that can lead to severe hepatotoxicity.

• 농촌의학ㆍ지역보건
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• 제30권2호
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• pp.241-249
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• 2005

군소(Aplysia Kurodai, sea hare)의 내장 또는 알을 섭취한 후 아플리시아닌(aplysianin) 자연독에 의해 독성간염이 발생할 수 있다. 저자들은 경상북도 울릉군 울릉의료원을 방문한 군소 알을 섭취한 후 급성 독성간염이 발생한 2예를 경험 하였기에 문헌 고찰과 함께 보고하는 바이다. 환자 A는 47세 남자로 2003년 5월 17일 울릉도 바닷가에서 군소와 알을 직접 채취하여 내장을 제거하고 삶아 먹은 10시간 30분 후 구역 및 구토, 복통, 수양성설사와 급성 독성간염이 발생하였다. 환자 B는 48세 남자로 2004년 5월 16일 울릉도 바닷가에서 군소와 알을 직접 채취하여 내장을 제거하고 삶아 먹은 10시간 30분 후 구역 및 구토, 복통, 수양성설사와 급성 독성간염이 발생하였다. 환자들은 내원 당시 탈수 소견을 보여 수액공급 및 혈청 전해질 불균형을 교정하고 전격간염으로 진행 여부를 관찰하면서 보존적 치료를 시행하여 호전되었다. 저자가 파악하기로는, 본 사례 보고가 군소 알을 섭취한 후 독성간염이 발생한 국내 첫 보고이다. 군소의 내장 또는 알을 섭취한 후 중독증이 발생할 수 있다는 사실을 의료인과 일반인이 인지하고 정확한 진단과 예방을 위하여 노력하여야 할 것이다.

• Clinical and Experimental Pediatrics
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• 제51권5호
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• pp.528-532
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• 2008

소아에서 약물 유발성 독성 간염은 비교적 흔하며 대부분 약을 끊으면 호전된다. 특히 항결핵약은 주요 유발 약물이다. 약물 유발성 독성 간염은 자가면역질환을 동반할 수 있으며, 이러한 원인으로 보고된 약제로는 주로 methyldopa, nitrofurantoin, minocycline, interferon 등이고, 항결핵약 보고는 드물다. 저자들은 갑상선염이 동반되고 항결핵약 isoniazid와 rifampin으로 유발된 약물 유발성 자가면역간염을 경험하였기에 국내에서 처음으로 문헌고찰과 함께 보고하는 바이다.

• Journal of Yeungnam Medical Science
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• 제4권2호
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• pp.159-163
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• 1987

저자들은 1987년 5월 21일부터 6월 6일까지 잉어의 변종인 향어의 담낭 및 답즙을 생식한 후 발생한 급성간염이 동반된 급성신부전 1예를 치험하였기에 보고하는 바이다.

• 대한한방내과학회지
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• 제21권5호
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• pp.869-872
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• 2000

Although there are a few reports concerning the hepatic injury of herbal medicine in western medicine, there is no reports concerning the hepatic injury of herbal medicine in oriental medicine. We experienced one case of the hepatic injury suggested toxic hepatitis (drug induced hepatitis) in the treatment of oriental medicine for cerebral infarction. We make a reports for the progress of treatment. One patient of Rt hemiparesis diagnosed cerebral infarction in Brain MRI was administered Taeumin Yuldahanso-tang, treated with physical therapy and improved in the state of Rt hemiparesis(Gr 2/3,4). In the course of treatment, the patient intermittently complained of general weakness, dizziness, pericephalic discomfort(頭不淸), nausea, both leg weakness so we changed Taeumin Yuldahanso-tang to Soyangin Dokwhaljiwhang-tang. Alter that, the patient complained of general weakness, abdominal discomfort, heat and fever($38.4^{\circ}C$). We recognized the elevated total bilirubin(1.7mg/dl), serum transaminase(AST534U/L ALT720U/L), serum gammg glutamyl transpepridase (GGT106mg/dl) and Alk phosphatase124U/L. In the abdominal ultrasonogram there is hepatomegaly (16.5cm). We supposed hepatic injury suggested toxic hepatitis(induced hepatitis) of herbal medicine. After we administered Saeng gan gunbi-tang for 2days and Alk phosphatase and GGT inadequately was elevated. After that, we stopped administering medicine and the serum transaminase, total bilirubin, serum gamma glutamyl transpeptidase and Alk phosphatase level was decreased. In the abdominal ultrasonogram there was no signal. In the case, we supposed that the changing Sasang constitution and Sasang herbal medicine may induce hepatic injury. We are suggesting the necessity of a test for the hepatic injury of herbal medicine.

• 생물정신의학
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• 제18권3호
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• pp.159-162
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• 2011

Venlafaxine is among the most widely prescribed antidepressants. It is extensively metabolized to O-desmethylvenlafaxine via cytochrome P450 (CYP) 2D6. We report a case of acute toxic hepatitis resulting from venlafaxine in a 54-year-old woman with pain disorder. During venlafaxine treatment, laboratory tests revealed elevated liver enzymes with a maximum of 169 IU/L for aspartate transaminase (AST) and 166 IU/L for alanine transaminase (ALT). AST and ALT levels returned to normal after 6 days of discontinuation of venlafaxine. The patient was finally diagnosed with acute toxic hepatitis through liver biopsy. This case indicates the importance that clinicians should be aware of the hepatotoxicity of venlafaxine in practice.

• Safety and Health at Work
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• 제9권3호
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• pp.356-359
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• 2018

This case report attempts to present a case of acute toxic hepatitis in fire extinguisher manufacturing workers exposed to 2,2-dichloro-1,1,1-trifluoro-ethane (HCFC-123) in August 2017 in Korea. Twenty-two-year-old male workers were exposed to HCFC-123 for 1.5 hours one day and for 2.5 hours the other day, after which one worker died, and the other recovered after treatment. The workers were diagnosed with acute toxicity of hepatitis. However, exposure levels of HCFC-123 were not known with no work environment measurement done. Therefore, this study was conducted to estimate the exposure concentration of HCFC-123 via a job simulation experiment. In the simulation, the HCFC-123 exposure concentration was measured with the same working practice and working time as with the workers aforementioned. As a result, the workers who infused HCFC-123 into storage tanks were estimated to be exposed to HCFC-123 at a concentration of $20.65{\pm}10.81ppm$, and a mean concentration of area samples within a working radius were estimated as $70.30{\pm}18.10ppm$. Valve assembly workers working on valves of a fire extinguisher filled with HCFC-123 were exposed to HCFC-123 at concentrations of $91.65{\pm}4.03ppm$ and $115.55{\pm}7.28ppm$, respectively, in the simulation, and area samples simulated within the working radius were also found to be high with concentrations of $122.75{\pm}91.15ppm$ and $126.80{\pm}60.25ppm$, respectively. Nitrogen gas packing workers, who did not handle HCFC-123 directly, were exposed to the agent at a concentration of $71.80{\pm}8.49ppm$. These results suggest that exposure to HCFC-123 at high concentrations for 1.5-2.5 hours caused acute toxic hepatitis in two workers.

• 대한한방내과학회지
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• 제32권3호
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• pp.444-450
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• 2011

Recently, acute toxic liver injury has been reported to be the most common cause of acute hepatitis. We witnessed one case of hepatic injury which suggested drug-induced hepatitis by herbal medication (Gamiyukgunja-tang). This patient, diagnosed cerebral infarction, was treated with herbal medication and physical therapy for improvement of right hemiparesis. In the course of treatment, this patient showed elevation of serum transaminase (ALT 129 IU/L, AST 150 IU/L), alkaline phosphatase (ALP 261 IU/L), and total bilirubin (2.0 IU/L), so we supposed toxic hepatitis by herbal medication. Saenggangeonbi-tang was administered for 8 days, ALT, AST, ALP, total bilirubin decreased within normal limits.