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- W2980095263 abstract "INTRODUCTION: The objective of this case is to become aware of the increasing number of agents with the potential to cause acute liver injury, in the modern age of combined allopathic and naturopathic medicine. CASE DESCRIPTION/METHODS: A 45 year old woman, recently emigrated from Honduras, presented with three weeks of epigastric pain and progressive jaundice. She denied high risk behaviors and endorsed NSAID use for headaches. Her exam was notable for marked scleral icterus and jaundice, but no stigmata of chronic liver disease. Labs were notable for AST 1893 IU/L, ALT 1454 IU/L, total bilirubin 16 mg/dL (direct bilirubin 12.4), ALP 209 IU/L, protein 6.4 g/dL, albumin 3.1 g/dL, INR 1.2. Urine drug screen, ethanol and acetaminophen levels were undetectable. A complete acute hepatitis viral panel and ceruloplasmin was negative except for a borderline anti smooth muscle antibody (1:40). Further workup was done including an abdominal ultrasound with dopplers showing normal gallbladder, no gallstones, and patent hepatic and portal vasculature, and an MRCP with small hepatic cysts and normal liver. No etiology was identified and her transaminases continued to rise as to AST 2230 IU/L and ALT 1895 IU/L. Liver biopsy showed periportal and cholestatic hepatitis with bridging necrosis consistent with drug induced liver injury. Further detailed history eventually yielded that she started an herbal remedy, arnica, around the same time she was developing jaundice. She was treated with N-acetylcysteine, and with continued abstinence of arnica, her liver enzymes normalized. DISCUSSION: There are innumerable supplements available to patients with purported health benefits, making it challenging to identify safety of use. arnica herbs are used as a topical agent to help with joint and muscle aches given its anti-inflammatory properties. Our patient had been using the herbs to create a concentrated tea. It is likely that the ingestion and systemic absorption led to her liver injury. This emphasizes the importance of thorough history taking with direct questioning, especially when diagnostic testing is unrevealing. Treatment is avoidance of the agent with expected improvement in liver enzymes." @default.
- W2980095263 created "2019-10-18" @default.
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- W2980095263 date "2019-10-01" @default.
- W2980095263 modified "2023-09-23" @default.
- W2980095263 title "2352 Herbal Teas: More Harmful Than Helpful?" @default.
- W2980095263 doi "https://doi.org/10.14309/01.ajg.0000598940.15587.8b" @default.
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