Korean J Med.  2010 Apr;78(4):457-465.

Clinical features of 28 acutely toxic hepatitis patients who ingested Dictamnus dasycarpus: A single center clinical experience

• Jung JH
• Kim SH
• Ko KH
• Jung KH
• Hwang SW
• Goh PG
• Park NH
• Nam GW
• Kim JI
• Moon HS
• Lee ES
• Sung JK
• Lee BS
• Lee HY
• Kang DY

Abstract

BACKGROUND/AIMS
The aim of this study was to investigate the clinical features of acutely toxic hepatitis associated with ingesting Dictamnus dasycarpus (D. dasycarpus).
METHODS
Between January 2004 and July 2009, 28 patients were enrolled in this study. We reviewed the medical records retrospectively. Acutely toxic hepatitis associated with D. dasycarpus was diagnosed by a Roussel Uclaf Causality Assessment Method Values (RUCAM) score of 6 or above. All patients were tested for viral hepatitis A, B, C, cytomegalovirus, and Epstein-Barr virus. Other tests included anti-nuclear antibody, anti-mitochondrial antibody, and anti-smooth muscle antibody. Abdominal pelvic computed tomography was performed.
RESULTS
The incidence was female predominant (64% vs. 36%). The mean patient age was 53.0+/-11 years. The symptoms were jaundice (68%), fatigue (57%), nausea (43%), anorexia (43%), and abdominal pain (24%). The mean RUCAM score was 7.0+/-0.8. The biochemical patterns of hepatotoxicity were hepatocellular (n=23, 82%) and mixed types (n=5, 18%). Radiologic findings were as follows: normal findings (29%), lymphadenopathy (50%), edema of the gall bladder wall (46%), periportal edema (43%), splenomegaly (11%), fatty liver (11%), and ascites (7%). The mean hospitalization period was 21.6+/-11.6 days. The mean duration of recovery from hepatitis was 56.6+/-30.4 days, and all patients recovered completely from the toxic hepatitis. One patient who had severe jaundice developed a complication of pure red cell aplasia during the hospitalization period.
CONCLUSIONS
The biochemical pattern of liver injury was hepatocellular predominant. Although the initial manifestations and clinical course were variable, all patients completely recovered with supportive care or steroid treatment. Toxic hepatitis was accompanied by pure red cell aplasia in one patient.

Keyword

Dictamnus dasycarpus; Toxic hepatitis; Pure red cell aplasia

MeSH Terms

Abdominal Pain
Anorexia
Ascites
Cytomegalovirus
Dictamnus
Drug-Induced Liver Injury
Edema
Fatigue
Fatty Liver
Female
Hepatitis
Hepatitis A
Herpesvirus 4, Human
Hospitalization
Humans
Incidence
Jaundice
Liver
Lymphatic Diseases
Medical Records
Muscles
Nausea
Red-Cell Aplasia, Pure
Retrospective Studies
Splenomegaly
Urinary Bladder