Cyanamide-induced liver dysfunction after abstinence in alcoholics: a long-term follow-up study on four cases.
BACKGROUND
Cyanamide, an aversive agent widely used in Japan, is known to induce various degrees of hepatic lesion with ground-glass inclusion bodies. When cyanamide-treated alcoholics relapse into drinking, more severe inflammation develops in the liver. However, it is controversial whether progressive hepatic lesions develop in complete abstainers as a result of long-term cyanamide treatment.


METHODS
Case 1: A 53-year-old male alcoholic received cyanamide treatment for 4.5 months and completely abstained without cyanamide treatment for 6 years. A liver biopsy shortly after abstinence showed extensive pericellular fibrosis, but a biopsy after 6 years showed very mild fibrosis. Case 2: A 43-year-old male alcoholic remained completely abstinent with cyanamide treatment for 5 years and complained of general fatigue. His serum transaminases were slightly elevated and hepatic hyperechogenicity was observed on ultrasonography. Only mild pericellular fibrosis was present in the liver biopsy specimen obtained shortly after abstinence, but after 5 years the second liver biopsy showed that thin septum-like fibrosis that formed portal-to-portal and portal-to-central linkage had developed and ground-glass hepatocytes had emerged extensively. Case 3: A 29-year-old female alcoholic complained of general fatigue and a slight fever after 1.5 years of abstinence with cyanamide treatment. Slight elevation of serum transaminases and hepatic hyperechogenicity were observed. The liver biopsy showed extensive ground-glass hepatocytes and thin septum-like fibrosis that formed portal-to-portal linkage. Case 4: A 61-year-old male alcoholic who remained completely abstinent while taking cyanamide for 3 years showed slight elevation of serum transaminases. Liver biopsy showed extensive ground-glass hepatocytes and extension of thin septum-like fibers from portal tract to the lobule. Ultrasonography revealed hepatic hyperechogenicity.


CONCLUSIONS
In some abstainers who take cyanamide for several years, thin septum-like liver fibrosis progresses along with the emergence of ground-glass hepatocytes. Hepatic hyperechogenicity on ultrasonography and slight elevation of serum transaminases might erroneously lead to a diagnosis of hepatic steatosis without liver histology.
Suzuki
Y
Y
National Institute on Alcoholism, Kurihama National Hospital, Yokosuka, Kanagawa, Japan.
Yokoyama
A
A
Nakano
M
M
Okuyama
K
K
Takahashi
H
H
Tamai
H
H
Maruyama
K
K
Ishii
H
H
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000427:Alcohol Deterrents / Q000009:adverse effects* / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy*; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury; D003484:Cyanamide / Q000009:adverse effects* / Q000627:therapeutic use; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000473:pathology; D008107:Liver Diseases / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
D000427:Alcohol Deterrents; D000431:Ethanol; D003484:Cyanamide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase