Clinical analysis of 58 cases of drug-induced liver injury between 1977 and 1998 *
Of 58 patients admitted to our division with drug-induced liver injury, 25 and 33 were treated between 1977 and 1988 and between 1989 and 1998, respectively. Comparisons were made between these two groups. The types of causative drugs were analgesics-antipyretics, antibiotics and cardiovascular drugs. The incidence of analgesics-antipyretics-induced liver injury has increased in recent years. Furthermore, herbal medicines, vitamins and health foods, which have been considered to be relatively safe, have also caused liver injury. The positive rate on drug lymphocyte stimulation tests and the incidence of drug-induced eosinophilia have tended to decrease in recent years. Total bilirubin and alkaline phosphatase levels have also tended to be lower in recent cases. The number of patients with cholestatic liver involvement has decreased, but hepatocellular injury has increased. It is most important to discontinue the causative agent when treating drug-induced liver injury, while liver protectors and corticosteroids have also been used. The period of hospitalization was significantly longer in patients with cholestatic liver damage. Severe drug-induced liver injury was noted in seven patients and four of them had a positive lymphocyte stimulation test result for multiple drugs. Fulminant hepatic failure was noted in two patients, one of whom died. In conclusion, analgesics-antipyretics have recently been the most common cause of drug-induced liver injury in our experience. The number of patients with a cholestatic presentation has decreased, but the hepatocellular pattern has increased. Furthermore, laboratory findings suggesting allergy have become less common and the number of patients classified as having definite drug-induced liver damage according to the Japanese criteria has decreased. (Accepted on May 27, 1999) Kawasaki Igakkaishi 25 (2) : 87-95,1999
