The Journal of Internal Korean Medicine (대한한방내과학회지)

The Society of Internal Korean Medicine (대한한방내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case Report of UDCA and Injinho-tang Co-administration for Liver Damage Caused by Rifampin

Rifampin으로 인한 간손상에 UDCA와 인진호탕 병용투여 증례 보고

  • Seyeon Lee (Dept. of Internal Medicine, Korean Medicine Hospital of Pusan National University) ;
  • Hansung Yoon (Dept. of Korean Medicine, School of Korean Medicine, Pusan National University) ;
  • Kibeom Ku (Dept. of Internal Medicine, Korean Medicine Hospital of Pusan National University) ;
  • Mariah Kim (Dept. of Internal Medicine, Korean Medicine Hospital of Pusan National University) ;
  • Irang Nam (Dept. of Internal Medicine, Korean Medicine Hospital of Pusan National University) ;
  • Minhwa Kim (Dept. of Internal Medicine, Korean Medicine Hospital of Pusan National University) ;
  • Changwoo Han (Dept. of Internal Medicine, Korean Medicine Hospital of Pusan National University)
  • 이세연 (부산대학교한방병원 한방내과) ;
  • 윤한성 (부산대학교 한의학전문대학원 한의학과) ;
  • 구기범 (부산대학교한방병원 한방내과) ;
  • 김마리아 (부산대학교한방병원 한방내과) ;
  • 남이랑 (부산대학교한방병원 한방내과) ;
  • 김민화 (부산대학교한방병원 한방내과) ;
  • 한창우 (부산대학교한방병원 한방내과)
  • Received : 2023.09.14
  • Accepted : 2023.10.30
  • Published : 2023.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

We have experienced a case in which herbal medicine was administered to treat drug-induced liver damage and would like to introduce it. A 49-year-old man exhibited a positive result in the interferon-gamma release assay. He had never suffered from tuberculosis in the past, and the route and time of infection could not be confirmed. He had no respiratory or systemic symptoms suggestive of active tuberculosis, and a chest X-ray examination showed no active lung lesions, so he was diagnosed with latent tuberculosis infection. He was confirmed to be within the normal range in the liver function test, renal function test, and complete blood cell count test, and started taking rifampin (600 mg qd). In the screening test performed on the 19th day of taking the drug, other test items were normal, but alanine aminotransferase (ALT) increased to 50 U/L (reference value: 4-40 U/L). In a test performed on the 29th day of taking the drug, ALT was clearly elevated to 102 U/L. Ursodeoxycholic acid and Injinho-tang were taken together with rifampin, and the patient's progress was observed. In a test performed 14 days later, ALT decreased to 26 U/L, within the normal range. It is presumed that Injinho-tang may have partially contributed to alleviating liver damage in this case.

Keywords

Acknowledgement

본 연구는 2022년도 부산대학교병원 임상연구비 지원으로 이루어졌음.

References

  1. Suk KT, Kim DJ. Drug-induced liver injury: present and future. Clin Mol Hepatol 2012 Sep;18(3):249-57. https://doi.org/10.3350/cmh.2012.18.3.249
  2. CIOMS Consensus report on Drug-Induced Liver Injury (DILI) Available from https://cioms.ch/wp-content/uploads/2020/07/CIOMS-CoRE-July-Webinar-SlideDeck_Final23Jul2020.pdf
  3. Fontana RJ, Liou I, Reuben A, Suzuki A, Fiel MI, Lee W, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology 2023;77(3):1036-65. https://doi.org/10.1002/hep.32689
  4. Jin SE, Jeong SJ, Shin HK, Ha H. Hepatoprotective effects of 25 herbal formulas in primary rat hepatocytes. JPPKM 2013;27(5):617-24.
  5. Kwon JY, Kim YJ, Park JK, Kong KH, Go HY. A case report of suggested liver dysfunction by atorvastatin treated with Saenggangeonbi-tang. J Int Korean Med 2017;38(5):548-54. https://doi.org/10.22246/jikm.2017.38.5.548
  6. Choi HS, Jung TY. One Case of Drug-Induced Liver Injury Treated with Saenggangeonbi-tang. J Int Korean Med 2004;25(4):207-11.
  7. Choi JW, Bae CW, Park SY, Yun HJ, Park SD. Protective effect of injinhotang and its components on acetaminophen-induced hepatoxicity in rats. Herbal formula science 2005;13(1):9-33.
  8. Danan G, Benichou C. Causality assessment of adverse reactions to drugs--I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol 1993;46(11):1323-30. https://doi.org/10.1016/0895-4356(93)90101-6
  9. Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al. Tuberculosis. Nat Rev Dis Primers 2016;2:16076.
  10. Horsburgh CR. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004;350(20):2060-7. https://doi.org/10.1056/NEJMsa031667
  11. Comstock GW. How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults? Int J Tuberc Lung Dis 1999;3(10):847-50.
  12. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management [Internet]. Available from https://www.who.int/publications/i/item/9789241550239 (Access 2023.09.05.)
  13. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Available from https://www.ncbi.nlm.nih.gov/books/NBK547852/ (Access 2023.09.05.)
  14. Lang SM, AI-Nemnem E, Schiffl H. Anti-tuberculosis drug induced liver injury and ursodeoxycholic acid. Journal of Tuberculosis Research 2020;8(20):66-72. https://doi.org/10.4236/jtr.2020.82007
  15. Saito Z, Kaneko Y, Kinoshita A, Kurita Y, Odashima K, Horikiri T, et al. Effectiveness of hepatoprotective drugs for anti-tuberculosis drug-induced hepatotoxicity: a retrospective analysis. BMC Infect Dis 2016;16(1):668.
  16. Wikipedia. Available from: https://zh.wikipedia.org/wiki/%E5%BC%B5%E4%BB%B2%E6%99%AF. (Access 2023.09.05.)
  17. 何伦. 实用处方纲目. 1st edition. 陜西: 陜西科学技术出版社; 1991, p. 427-9.
  18. Park KJ, Kang HK, Han CW. Clinical effect of Injinho-tang on hyperbilirubinemia in hepatobiliary disorders: a systematic review. J Int Korean Med 2022;43(6):1149-61. https://doi.org/10.22246/jikm.2022.43.6.1149
  19. Yang Q, Yang F, Tang X, Ding L, Xu Y, Xiong Y, et al. Chlorpromazine-induced perturbations of bile acids and free fatty acids in cholestatic liver injury prevented by the Chinese herbal compound Yin-Chen-Hao-Tang. BMC Complement Altern Med 2015;15:122.
  20. Tao W, Zhu W, Nabi F, Li Z, Liu J. Penthorum chinense Pursh compound flavonoids supplementation alleviates Aflatoxin B1-induced liver injury via modulation of intestinal barrier and gut microbiota in broiler. Ecotoxicol Environ Saf 2023;255:114805.
  21. Mase A, Makino B, Tsuchiya N, Yamamoto M, Kase Y, Takeda S, et al. Active ingredients of traditional Japanese (kampo) medicine, inchinkoto, in murine concanavalin A-induced hepatitis. J Ethnopharmacol 2010;127(3):742-9. https://doi.org/10.1016/j.jep.2009.11.029
  22. Yan J, Xie G, Liang C, Hu Y, Zhao A, Huang F, et al. Herbal medicine Yinchenhaotang protects against α-naphthylisothiocyanate-induced cholestasis in rats. Sci Rep 2017 Jun 23;7(1):4211.
  23. Zhang H, Wang X, Hu P, Zhou W, Zhang M, Liu J, et al. Serum metabolomic characterization of liver fibrosis in rats and anti-fibrotic effects of Yin-Chen-Hao-Tang. Molecules 2016;21(1):E126.
  24. Korean Guidelines For Tuberculosis Fourth Edition. Available from: https://www.medric.or.kr/Uploads/BLibrary/%EA%B2%B0%ED%95%B5%EC%A7%84%EB%A3%8C%EC%A7%80%EC%B9%A8(4%ED%8C%90)(2020).pdf