Korean J Gastroenterol.  2015 Jun;65(6):375-378. 10.4166/kjg.2015.65.6.375.

A Case of Lead Poisoning with Drug-induced Liver Injury after Ingestion of Herbal Medicine

• Jeon GJ
• Park J
• Kim MS
• Yu JW
• Park JH
• Kim MS

• KMID: 2373241
• DOI: http://doi.org/10.4166/kjg.2015.65.6.375

Abstract

A 61-year-old male patient was admitted because of unexplained abdominal pain and anemia. His past medical history was unremarkable except for having taken herbal medicine to treat facial palsy two months ago. The result of health examination performed about a month ago showed increased serum aspartate and alanine aminotransferase level, and he was diagnosed with toxic hepatitis by herbal medicine. When the patient presented to the outpatient department three weeks ago, follow-up liver function test results showed improvement but he complained of abdominal pain. Despite extensive blood chemistry tests and computed tomography, the cause of pain could not be found. After much deliberation, serum lead level and herbal medicines analysis was performed based on the fact that he took herbal medicine two months ago, and he could finally be diagnosed with lead poisoning. Since the serum lead level was high enough to be indicated for lead chelating therapy, conservative management was given. When a patient with toxic hepatitis due to herbal medication presents with abdominal pain, the possibility of lead poisoning should always be taken into consideration.

Keyword

Lead poisoning; Toxic hepatitis; Herbal medicine

MeSH Terms

Acute Disease
Alanine Transaminase/analysis
Aspartate Aminotransferases/analysis
Chemical and Drug Induced Liver Injury/*diagnosis
Hemoglobins/analysis
Humans
Lead/analysis
*Lead Poisoning
Liver/enzymology/metabolism
Liver Function Tests
Male
Middle Aged
Plants, Medicinal/chemistry
Alanine Transaminase
Aspartate Aminotransferases
Hemoglobins
Lead

Figure

• 

  Fig. 1. Change in serum hemoglobin level. Serum hemoglobin (Hb) level gradually declined up until transfusion was given (white arrow). The hemoglobin level at first visit after discharge (black arrow) remains similar to that after transfusion and shows slow recovery during follow-up period after discharge.

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  Fig. 2. Changes in AST, ALT, and total billirubin. AST, ALT, and total bilirubin all improved with time.

Reference

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