LETTERS
low-titer antinuclear antibodies on HEp-2 substrate (7,8). In a series of 62 patients with PCT and hepatitis C infection, no patient had serum autoantibodies (9). However, active hepatitis C infection may cause cryoglobulinemia and mimic SLE (7,101. Cryoglobulinemia is characterized by arthritis, vasculitis, glomerulonephritis, and autoantibodies. Our patient had no clinical evidence of vasculitis, chronic hepatitis, or glomerulonephritis to suggest cryoglobulinemia associated with hepatitis C infection. In addition, she had SLE for years prior to the onset of hydroxychloroquineinduced PCT.
I agree wholeheartedly with Drs. Nepveu and Libman that patients with PCT or SLE who have elevations found on liver function tests should be tested for hepatitis A, B, and C. 1 that contain undeclared prescription drugs (1). Interesting as this is, the article makes no mention of the existence of adverse effects associated with certain Chinese herbs themselves (2). Several renal diseases (e.g., acute tubular necrosis, Fanconi's syndrome, renal fibrosis) associated with the use of these herbs have been reported (3).
Chineses herb nephropathy (CHN) was first described in 1993, involving a group of patients on a slimming regimen. The condition was related to the action of Stephania tetrandra and Magnolia oficinalis contained in "Chinese pills" (4). CHN is characterized by a rapidly progressive fibrosing interstitial nephritis, leading, in most cases, to end-stage renal disease (3,4). Interestingly, when chemically tested, the medications did not show nephrotoxic contaminants of fungal or plant origin, or adulteration by antiinflammatory drugs or diuretics (4). In their article, Gertner et al emphasize the presence of undeclared substances in the Chinese medications, implying that these substances were etiologic factors in the development of the adverse effects, but they fail to mention the exact herbal COmpOSitiOn.