title: Two cases of food additive-induced severe liver damage associated with positive results on lymphocyte stimulation test and for antinuclear antibodies.
abstract: Two cases of severe liver injury and positive result for antinuclear antibodies induced by food additives are reported. The first patient reported long-term intake of Mabo Ramen(®) noodle soup, nutritional supplements, and over-the-counter drugs. Total bilirubin, aspartate aminotransferase, and alanine aminotransferase were 9.6 mg/dL, 1,048, and 1,574 IU/L, respectively. Antinuclear antibody was 80×. The drug-induced lymphocyte stimulation test (DLST) was positive for Mabo Ramen(®) and its additives such as Xanthan gum, guar gum, and Doubanjiang. Histologic examination of a liver biopsy specimen showed lymphocyte infiltration and necrosis. The autoimmune hepatitis score was 3. The second patient reported intake of dietary supplements, including Bimore C(®) and Chokora BB(®). Laboratory tests revealed that total bilirubin was 9.8 mg/dL, aspartate aminotransferase was 1,130 IU/L, and alanine aminotransferase was 1,094 IU/L. Antinuclear antibody was 320×. Co-existing pancreatic damage was confirmed by the findings on abdominal CT and elevation of serum lipase, span-1, and DUPAN-2. DLSTs were positive for both supplements. These two supplements contained additives such as titanium oxide, magnesium stearate, and hydroxypropylcellulose. DLSTs for all three additives were positive. Histologic examination revealed periportal necrosis and lymphocyte infiltration of lobular and portal areas. These two cases demonstrate that repeating DLSTs is useful for identifying causative constituents in foods and supplements.
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan. s8030@nms.ac.jp.|Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. s8030@nms.ac.jp.
authors.forename: Rena
authors.initials: R
authors.lastname: Kaneko
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Chitose
authors.initials: C
authors.lastname: Ohishi
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Miniru
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Shiina
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kusayanagi
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Munakata
authors.affiliation: Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Japan Labor Health and Welfare Organization, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Sato
keywords: DUPAN-2; Drug-induced lymphocyte stimulation test; Food additives; Hepatitis; Pancreatitis