PDF(Pubmed)
Abstract：
Immune-mediated herb-induced liver injury (HILI) is an acute or chronic inflammatory liver disease precipitated by a hepatotoxic agent with a presentation similar to acute autoimmune hepatitis. It is distinguished in clinical course from true autoimmune hepatitis by remission on drug discontinuation and immunosuppressive treatment. We report a potential case of immune-mediated HILI associated with artemisinin use, an herb underlying first-line malarial treatments, in a woman undergoing radiotherapy for right-sided pelvic sarcoma. A probable association in this case is supported by causality assessment using the updated Roussel Uclaf Causality Assessment Method (score of 6). She achieved clinical improvement with a course of oral corticosteroids and remained stable without relapse following discontinuation. Increased awareness of this complication is imperative, as literature to date only documents direct hepatocellular and cholestatic liver injury from artemisinin use, and should augment clinician counsel regarding complementary medicine administration, especially in high-risk individuals like those with cancer.
摘要：
免疫介导的草药诱导的肝损伤（HILI）是由肝毒性剂沉淀的急性或慢性炎症性肝病，其表现类似于急性自身免疫性肝炎。在临床过程中，它与真正的自身免疫性肝炎的区别在于药物停药和免疫抑制治疗的缓解。我们报告了与青蒿素使用相关的免疫介导的HILI的潜在病例，一线疟疾治疗的草药，一名接受右侧盆腔肉瘤放射治疗的妇女。使用更新的RousselUclaf因果关系评估方法（得分为6）的因果关系评估支持了这种情况下的可能关联。通过一个疗程的口服皮质类固醇，她获得了临床改善，并且在停药后保持稳定而无复发。必须提高对这种并发症的认识，迄今为止的文献仅记载了青蒿素的直接肝细胞和胆汁淤积性肝损伤，并应增加有关补充医学管理的临床医生顾问，尤其是像癌症患者这样的高危人群。
