title: [Unknown fever and abnormal liver functions after repeated epidural blocks with lidocaine for management of herpes zoster pain].
abstract: We present a case of unknown fever and abnormal liver functions which developed during the course of pain management for herpes zoster with repeated epidural blocks with 0.5% lidocaine 10 ml. The patient was a 67 year old woman. At her first admission to dermatology, there were no abnormal findings in her blood examinations. She complained of severe pain from herpes zoster. She was admitted to the pain clinic. She received thoracic epidural blocks with 0.5% lidocaine 10 ml repeatedly three or four times a week. Two weeks later, she developed general fatigue, appetite loss, nausea and a high fever. Blood examinations revealed the elevation of glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase (ALP), and gamma glutamyltrans peptidase (gamma-GTP), C reactive protein (CRP), and blood sedimentation rate (BSR). Many examinations including abdominal and thoracic computer tomography and abdominal echograph could not reveal the cause of high fever and abnormal blood examinations. We continued the thoracic epidural block for her herpes zoster pain. GOT, GPT, ALP, and gamma-GTP gradually went down to normal values in next two weeks, though fever still persisted. At this time, lymphocyte cell simulation test with 0.5 % lidocaine was positive and eosinophylic cell had increased to 5%. After ceasing the epidural block, fever resolved and blood examinations returned to normal values. These findings suggest strongly that 0.5% lidocaine induced fever and hepatitis.
authors.affiliation: Department of Anesthesiology, Ibi General Hospital, Gifu.
authors.forename: H
authors.initials: H
authors.lastname: Uematsu
authors.forename: K
authors.initials: K
authors.lastname: Hiei
authors.forename: H
authors.initials: H
authors.lastname: Kawasaki
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D005335:Fever of Unknown Origin / Q000139:chemically induced*; D006562:Herpes Zoster / Q000150:complications* / Q000628:therapy; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects* / Q000276:immunology
chemical_list: D008012:Lidocaine