Yoshikawa K, Kawashima R, Hirose Y, Shibata K, Akasu T, Hagiwara N, Yokota T, Imai N, Iwaku A, Kobayashi G, Kobayashi H, Kinoshita A, Fushiya N, Kijima H, Koike K, Saruta M. Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids. World J Gastroenterol 2017; 23(27): 5034-5040 [PMID: 28785156 DOI: 10.3748/wjg.v23.i27.5034]
Corresponding Author of This Article
Kenichi Yoshikawa, MD, PhD, Division of Gastroenterology and Hepatology, Internal Medicine, the Jikei University Daisan Hospital, 4-11-1 Izumihon-cho, Komae-shi, Tokyo 201-8601, Japan. kyoshikawa@jikei.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
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Yoshikawa K, Kawashima R, Hirose Y, Shibata K, Akasu T, Hagiwara N, Yokota T, Imai N, Iwaku A, Kobayashi G, Kobayashi H, Kinoshita A, Fushiya N, Kijima H, Koike K, Saruta M. Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids. World J Gastroenterol 2017; 23(27): 5034-5040 [PMID: 28785156 DOI: 10.3748/wjg.v23.i27.5034]
Kenichi Yoshikawa, Reimi Kawashima, Yuki Hirose, Keiko Shibata, Takafumi Akasu, Noriko Hagiwara, Takeharu Yokota, Nami Imai, Akira Iwaku, Go Kobayashi, Hirohiko Kobayashi, Akiyoshi Kinoshita, Nao Fushiya, Hiroyuki Kijima, Kazuhiko Koike, Division of Gastroenterology and Hepatology, Internal Medicine, the Jikei University Daisan Hospital, Tokyo 201-8601, Japan
Masayuki Saruta, Division of Gastroenterology and Hepatology, Internal Medicine, the Jikei University School of Medicine, Tokyo 105-8471, Japan
Author contributions: All authors contributed equally to this work; Yoshikawa K and Kawashima R conducted the medical examinations, analyzed the data, explained the condition to the patient, and provided the treatment; Yoshikawa K wrote the manuscript’s text; Kinoshita A wrote the supplementary information; all of the authors discussed the results and commented on the manuscript at all stages.
Institutional review board statement: The study was reviewed and approved by the IRB of the Jikei University School of Medicine.
Informed consent statement: We received patient consent with regard to this manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Correspondence to: Kenichi Yoshikawa, MD, PhD, Division of Gastroenterology and Hepatology, Internal Medicine, the Jikei University Daisan Hospital, 4-11-1 Izumihon-cho, Komae-shi, Tokyo 201-8601, Japan. kyoshikawa@jikei.ac.jp
Telephone: +81-3-34801151 Fax: +81-3-34303611
Received: March 25, 2017 Peer-review started: March 29, 2017 First decision: May 12, 2017 Revised: June 9, 2017 Accepted: June 18, 2017 Article in press: June 19, 2017 Published online: July 21, 2017 Processing time: 117 Days and 18.5 Hours
Abstract
We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid (ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury, and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa, from the rectum to the anus, and this is the first description of a case that developed a severe liver disorder after this treatment; hence, an analysis of future cases as they accumulate is desirable.
Core tip: The definition of drug-induced liver injury has diversified in recent years. This report describes the characteristics of a case of acute liver injury that developed after internal hemorrhoid treatment using the aluminum potassium sulfate and tannic acid regimen, and it is the first report of a case of drug-induced liver injury caused by a rectal submucosal injection.
