[Clinical experience of 48 acute toxic hepatitis patients].
OBJECTIVE
Although many individual cases of toxic hepatitis have been reported in Korea, there are few comprehensive systematic studies on acute toxic hepatitis. The first aim of this study is to investigate the frequency and clinical characteristics of acute toxic hepatitis patients. The second aim of this study is to investigate the efficacy of steroid therapy for immunoallergic idiosyncrasy.


METHODS
Between March 1998 and March 2004 forty eight patients were included in this study. The medical records were reviewed retrospectively. Acute toxic hepatitis was diagnosed by score of more than 3 in RUCAM criteria. All the patients were tested for hepatitis A, B and C. Other tests included antibodies to CMV and EBV, ANA, AMA and SMA.


RESULTS
Seventy-three percent of the patients were female and the mean age of the patients was 47. Twenty cases of acute toxic hepatitis (42%) were related to prescribed medications. The other causes were herbs (35%) and traditional therapeutic preparations (23%). Common symptoms were jaundice (35%), fatigue (10%), fever (9%) and abdominal pain (9%). The biochemical pattern of hepatotoxicity was divided into three groups: hepatocellular (81%), mixed (13%), and cholestatic types (6%). Three patients who have prolonged and severe jaundice were classified into immunoallergic idiosyncrasy based upon clinical and histologic findings. Prednisolone was prescribed in all three cases whose bilirubin levels had been higher than 15 mg/dL for at least 7 days. Jaundice and the laboratory findings rapidly improved within 8 days since the treatment began.


CONCLUSIONS
In a demographic point of view, most patients of acute toxic hepatitis were middle aged women. Jaundice was the most commonly observed symptom. Prescribed drugs were the most common cause of acute toxic hepatitis. Although most cases of toxic hepatitis will recover with supportive care after cessation of the causative agent, steroid treatment may be helpful for the patients with severe jaundice patients who have immunoallergic idiosyncrasy.
Department of Internal Medicine, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea.
Jeong Chul
JC
Seo
Won Joong
WJ
Jeon
Sung Soon
SS
Park
Seok Hyung
SH
Kim
Ki Man
KM
Lee
Hee Bok
HB
Chae
Seon Mee
SM
Park
Sei Jin
SJ
Youn
D000208:Acute Disease; D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007565:Jaundice / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use
D005938:Glucocorticoids; D011239:Prednisolone