<症例>副腎皮質ステロイド剤が重篤な肝障害を惹起したと考えられるネフローゼ症候群の1例

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This is a case report of severe hepatitis induced by the administration of corticosteroids. A 58-year-old female was admitted on August 18,1986,because of leg edema caused by nephrotic syndrome. Proteinuria improved within two weeks after treatment with prednisolone given orally 50mg per day. SGOT, SGPT and γ-GTP showed transient slight elevation by this treatment. Soon after withdrawal of prednisolone, proteinuria exacerbated. Oral prednisolone, 40 mg per day was started and some amelioration of proteinuria was observed. By this second treatment with prednisolone, SGOT, SGPT and γ-GTP were again elevated. During withdrawal of prednisolone, there was a marked aggravation of proteinuria. Corticosteroid pulse therapy and immunosuppression therapy with cyclophosphamide were begun in February, 1987. SGOT, SGPT and γ-GTP were elevated to 259U/l, 548U/l and 2,650U/l, respectively with slight elevation of total bilirubin. This treatment reduced the proteinuria. After the treatment, SGOT, SGPT and γ-GTP were reduced approximately 50%. Oral prednisolone, 20 mg per day was started as a maintenance dose for proteinuria on May, 1987. During this maintenance dose, SGOT, SGPT, γ-GTP and total bilirubin were again elevated markedly. The patient died of gastric bleeding and acute necrotic pancreatitis on July 3,1987. The peak value of SGOT, SGPT and total bilirubin measured several days before her death were 1,035 U/l, 531 U/l and 43.9 mg/dl, respectively. The elevation of SGOT, SGPT and γ-GTP after each administration of prednisolone suggested allergic hepatitis caused by prednisolone. Postmortem examination revealed intrahepatic cholestasis consistent with the diagnosis of allergic hepatitis. This is a relatively rare case of allergic hepatitis caused by steroid therapy.
近畿大学の論文
1992-12-25

<症例>副腎皮質ステロイド剤が重篤な肝障害を惹起したと考えられるネフローゼ症候群の1例

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