HOMOLOGOUS SERUM HEPATITIS IN YOUTHFUL HEROIN USERS

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Abstract
Of the 21 persons who used heroin intravenously over an 18 month period 13 gave histories of one or more attacks of jaundice. All of these patients were at least 4 months convalescent at the onset of the follow-up study. Six of the 13 patients recovered completely in a 6 to 8 month period. Six others had abnormal liver function tests 4, 5, 6, 11, 18, and 19 months after their initial illness. Among the 8 patients without a previous history of jaundice, there were 3 who ultimately developed frank jaundice and 4 with episodes of anicteric hepatitis. Definite clinical signs and symptoms of persistent liver disease were present in only 4 patients, but chemical evidence of hepatic dysfunction was present in 14 of the 21 patients. This high incidence of subclinical liver disease was demonstrated by elevations in bromsulphalein retention and the serum glutamic oxalacetic trans-aminase (SGO-T). The latter test correlated best with the clinical course. Remaining liver function tests (total and prompt reacting (1) serum bilirubin, serum protein with albumin-globulin fractionation, zinc sulfate turbidity, thymol turbidity, serum alkaline phosphatase, total cholesterol and percentage of esters, and urinary urobilinogen) were of less significance as indicators of hepatic dysfunction. The SGO-T was the only abnormal test in 3 patients in the pre-icteric stage of their illness, and in those 4 patients who had episodes of anicteric hepatitis. The test was not influenced by administration of narcotics or adulterants. Case reports are presented which illustrate the usefulness of the SGO-T in detection of subclinical hepatic disease. The explanation for the unusually high incidence of persistent or recurrent liver dysfunction in this group of young adults is not readily apparent. Poor diet, alcoholism, continued use of narcotics, inadequate treatment, or strenuous activity do not seem be be significant factors. In the absence of any other obvious explanation, reinfection with the same or with different strains of virus remains a real possibility.