[Gold-induced severe cholestatic jaundice in rheumatoid arthritis patient and effect of repeated steroid pulse therapy].
A 32-year-old female with early stage of rheumatoid arthritis (RA) developed anorexia, pruritus, dark urine, pale stool and jaundice 3 weeks after initiation of chrysotherapy. She was administered a total of 35mg of gold sodium thiomalate (GST) intramuscularly and auranofin 6mg per day orally. Liver function tests and biopsy specimens showed severe cholestatic jaundice. Prednisolone 30mg per day and plasma exchange were started. No response however was obtained and the total bilirubin level gradually increased. Steroid pulse therapy, 1000mg methylprednisolone for successive 3 days as one therapy unit, was repeated 4 times. Liver functions were then gradually improved. Gold induced hepatotoxicity is a rare complication. We concluded that the hepatotoxicity in this case was caused by allergic reaction against GST and repeated steroid pulse therapy was very effective to these conditions.
Yamanishi
Y
Y
Immunology and Rheumatology Division, Saijo Central Hospital, Higashi-Hiroshima City.
Takeda
M
M
Honjo
N
N
Aoi
K
K
Ishibe
Y
Y
Yamana
S
S
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001310:Auranofin / Q000009:adverse effects*; D002779:Cholestasis / Q000139:chemically induced* / Q000188:drug therapy; D004334:Drug Administration Schedule; D005260:Female; D006052:Gold Sodium Thiomalate / Q000009:adverse effects*; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*
D006052:Gold Sodium Thiomalate; D001310:Auranofin; D008775:Methylprednisolone