Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2017; 23(27): 5034-5040
Published online Jul 21, 2017. doi: 10.3748/wjg.v23.i27.5034
Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids
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, Masayuki Saruta
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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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.

Keywords: Aluminum potassium sulfate and tannic acid injection; Aluminum potassium sulfate and tannic acid therapy; Rectal submucosal injection; Drug-induced lymphocyte stimulation test; Drug-induced liver injury

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.