Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilatation of the pancreatic duct, excessive mucin production, and papillary growth of the tumor. Occasionally, it forms a fistula into other organs. Because of the higher malignant potential of the main duct type IPMN compared to the branch duct type, patients with main duct type IPMN usually undergo surgical treatment and the natural history of the main duct type IPMN is not commonly observed in clinical practice. An 84-year-old woman was diagnosed with main duct type IPMN of pancreas, but she refused operative treatment. Seven years later she was admitted by chance for another disease, and then referred to our gastrointestinal department. We think this case can give us an insight of the natural course of the main duct type IPMN. (Korean J Helicobacter Up Gastrointest Res 2012;12:284-287)