抄録
We report on a case of rhabdomyolysis induced by Shakuyaku-kanzo-To, a herbal medicine for spastic muscle pain. The patient was a 76-year-old female who received Shakuyaku-kanzo-To (TJ-68) and dichlofenac for lumbago. Fifteen weeks later, she was admitted to hospital because of liver dysfunction as determined from increases in AST, ALT and LDH. She was diagnosed with rhabdomyolysis due to marked elevation of CPK and myogloblin levels. The hypertension, hypokalemia and reduced renin and aldosterone levels that were also noted suggested that the rhabdomyolysis was associated with pseudoaldosteronism caused by the licorice extracts contained by Shakuyaku-kanzo-To. We confirmed that blood levels of glycyrrhetinic acid (257 ng/mL), a licorice component known to induce pseudoaldosteronism, were high and found the serum cortisone/cortisol ratio (O.09) to be low indicating reduced activity of 11 β-hydroxysteroid dehydrogenase, which catalyzes the conversion of cortisol to cortisone. The results we obtained suggested that blood glycyrrhetinic acid levels and cortisone/cortisol ratios could be used as diagnostic indicators for pseudoaldosteronism caused by herbal remedies containing licorice extracts.
