A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature

Menotrophin is a protein-based hormonal therapy. It is used as a fertility medication that is given as injection either subcutaneously or intramuscularly. Menotrophin has not been previously reported to cause drug-induced liver injury. Drug-induced liver injury (DILI) is commonly seen nowadays with the expansion of the drug industry. It is associated with prescribed medications, over the counter drugs, herbal and dietary supplements. We report the first case of Menotrophin-induced autoimmune hepatitis in a 26-year-old Caucasian woman who was diagnosed with primary infertility due to failure to conceive after five years of marriage. She had received several cycles of Menotrophin, then developed new onset jaundice and fatigue associated with increase in transaminases. She had normal baseline liver function and enzymes prior to receiving treatment with Menotrophin. Evaluation showed no evidence of viral hepatitis, metabolic, alcoholic or vascular causes of liver injury. Autoimmune screening was positive for antinuclear antibody (ANA) with titer of 1 : 640 fine speckled, immunoglobulin G (IgG) level was 1900 mg/dl. Antimitochondrial antibodies (AMA) and antismooth muscle antibodies were negative. Liver biopsy showed features of chronic hepatitis with interface hepatitis and prominence of plasma cells, which best reflects autoimmune hepatitis. Her liver enzymes and bilirubin completely normalized after discontinuation of further Menotrophin therapy and starting treatment with prednisolone and Azathioprine.

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Chinese Skullcap in Move Free Arthritis Supplement Causes Drug Induced Liver Injury and Pulmonary Infiltrates

Case Reports in Hepatology ◽

10.1155/2013/965092 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Renumathy Dhanasekaran ◽

Victoria Owens ◽

William Sanchez

Keyword(s):

Liver Injury ◽

Case Reports ◽

Pulmonary Complications ◽

Adverse Outcomes ◽

Medical Community ◽

Temporal Association ◽

Drug Induced ◽

Over The Counter ◽

Drug Induced Liver Injury ◽

Pulmonary Infiltrates

Herbal medications are being increasingly used by the American population especially for common conditions like arthritis. They have been reported to cause adverse effects, including significant hepatotoxicity, but reporting remains sporadic. We report here a patient who developed drug induced liver injury following the intake of Move Free, which is an over-the-counter arthritis supplement. We propose that Chinese skullcap, which is one of the herbal ingredients of the medication, is responsible for the adverse event. There was a strong temporal association between the intake of supplement and onset of symptoms, and also there have been a few recent case reports implicating the same component. A unique observation in our case is the occurrence of pulmonary infiltrates simultaneously with the hepatotoxicity, and this side effect has not been well documented before. Both the hepatic and pulmonary complications completely resolved over few weeks after the patient stopped taking the medication. Since these supplements are readily available over the counter, we feel that it is important to document possible adverse outcomes to raise awareness in the medical community and also among patients.

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A patient with Gilbert's syndrome complicated with drug-induced liver injury by the over-the-counter drug and Fluvastatin Sodium: A case report

Kanzo ◽

10.2957/kanzo.50.139 ◽

2009 ◽

Vol 50 (3) ◽

pp. 139-144

Author(s):

Minoru Ayada ◽

Tetsuya Ishikawa ◽

Akihiko Okumura ◽

Naoki Hotta ◽

Akinori Hirose ◽

...

Keyword(s):

Case Report ◽

Liver Injury ◽

Drug Induced ◽

Over The Counter ◽

Gilbert’S Syndrome ◽

Drug Induced Liver Injury ◽

Gilbert's Syndrome

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Screening for Susceptibility-Related Biomarkers of Diclofenac-Induced Liver Injury in Rats Using Metabolomics

Frontiers in Pharmacology ◽

10.3389/fphar.2021.693928 ◽

2021 ◽

Vol 12 ◽

Author(s):

Can Tu ◽

Yuan Gao ◽

Di Song ◽

Ming Niu ◽

Run-ran Ma ◽

...

Keyword(s):

Liver Injury ◽

Inflammatory Responses ◽

Underlying Mechanism ◽

Drug Induced ◽

Over The Counter ◽

Receiver Operating Characteristic Curves ◽

Drug Induced Liver Injury ◽

Unmet Demand ◽

Diagnostic Capabilities ◽

Acute Phase Reactions

Early identification of individuals susceptible to idiosyncratic drug-induced liver injury (IDILI) is a challenging unmet demand. Diclofenac, one of the most widely available over-the-counter drugs for pain management worldwide, may induce liver dysfunction, acute liver failure, and death. Herein, we report that diclofenac-related hepatobiliary adverse reactions occurred more frequently in cases with immune activation. Furthermore, experiments with rats demonstrated divergent hepatotoxicity responses in individuals exposed to diclofenac, and modest inflammation potentiated diclofenac-induced liver injury. Susceptible rats had unique plasma metabolomic characteristics, and as such, the metabolomic approach could be used to distinguish susceptible individuals. The 23 identified susceptibility-related metabolites were enriched by several metabolic pathways related to acute-phase reactions of immunocytes and inflammatory responses, including sphingolipid, tyrosine, phenylalanine, tryptophan, and lipid metabolism pathways. This finding implies a mechanistic role of metabolic and immune disturbances affects susceptibility to diclofenac-IDILI. Further nine metabolite biomarkers with potent diagnostic capabilities were identified using receiver operating characteristic curves. These findings elucidated the potential utility of metabolomic biomarkers to identify individuals susceptible to drug hepatotoxicity and the underlying mechanism of metabolic and immune disturbances occurring in IDILI.

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Drug-induced Liver Injury with Serious Multiform Exudative Erythema following the Use of an Over-the-counter Medication Containing Ibuprofen

Internal Medicine ◽

10.2169/internalmedicine.54.3204 ◽

2015 ◽

Vol 54 (4) ◽

pp. 395-399 ◽

Cited By ~ 4

Author(s):

Takao Watanabe ◽

Masanori Abe ◽

Fujimasa Tada ◽

Kanako Aritomo ◽

Hironori Ochi ◽

...

Keyword(s):

Liver Injury ◽

Drug Induced ◽

Over The Counter ◽

Drug Induced Liver Injury ◽

Counter Medication

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Drug-Induced Liver Injury: An Institutional Case Series and Review of Literature

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709618761754 ◽

2018 ◽

Vol 6 ◽

pp. 232470961876175 ◽

Cited By ~ 2

Author(s):

Vijay Gayam ◽

Mazin Khalid ◽

Binav Shrestha ◽

Muhammad Rajib Hossain ◽

Sumit Dahal ◽

...

Keyword(s):

Liver Injury ◽

Case Series ◽

Review Of Literature ◽

Drug Induced ◽

Drug Induced Liver Injury

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A Rare Case of Drug-Induced Liver Injury Arising from Pain Balls: Case Report and Review of Literature

The American Journal of Gastroenterology ◽

10.14309/00000434-201210001-00458 ◽

2012 ◽

Vol 107 ◽

pp. S191

Author(s):

Siddharth Bansal ◽

Alexander Mallari ◽

Radu Serban ◽

Jason Gutman ◽

Joel McFarland

Keyword(s):

Case Report ◽

Liver Injury ◽

Rare Case ◽

Review Of Literature ◽

Drug Induced ◽

Drug Induced Liver Injury

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Acute Hepatitis Secondary to the Use of Ilex paraguariensis (Mate Tea): A Case Report and Review of Literature

Case Reports in Hepatology ◽

10.1155/2019/8459205 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Eduardo A. Rodriguez ◽

Raquel Teixeira Yokoda ◽

David E. Payton ◽

Rish Pai ◽

Thomas J. Byrne

Keyword(s):

Case Report ◽

Liver Injury ◽

Acute Hepatitis ◽

Herbal Product ◽

Ilex Paraguariensis ◽

Yerba Mate ◽

Review Of Literature ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Mate Tea

Drug induced liver injury is a very frequent cause of hepatotoxicity and within that group, herbal and dietary supplements are a well described subcategory. The following clinical vignette describes the case of a young man with acute hepatitis secondary to the use of Ilex paraguariensis, also known as yerba mate, which is a herbal product commonly drunk in South America. This is the first written case of mate tea induced hepatotoxicity.

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Paradoxical Patterns of Sinusoidal Obstruction Syndrome-Like Liver Injury in Aged Female CD-1 Mice Triggered by Cannabidiol-Rich Cannabis Extract and Acetaminophen Co-Administration

Molecules ◽

10.3390/molecules24122256 ◽

2019 ◽

Vol 24 (12) ◽

pp. 2256 ◽

Cited By ~ 7

Author(s):

Laura E. Ewing ◽

Mitchell R. McGill ◽

Eric U. Yee ◽

Charles M. Quick ◽

Charles M. Skinner ◽

...

Keyword(s):

Liver Injury ◽

Clinical Biochemistry ◽

Sesame Oil ◽

Glutathione Depletion ◽

Sinusoidal Obstruction Syndrome ◽

Drug Induced ◽

Over The Counter ◽

Drug Induced Liver Injury ◽

Cannabis Extract ◽

And Oxidative Stress

The goal of this study was to investigate the potential for a cannabidiol-rich cannabis extract (CRCE) to interact with the most common over-the-counter drug and the major known cause of drug-induced liver injury–acetaminophen (APAP)–in aged female CD-1 mice. Gavaging mice with 116 mg/kg of cannabidiol (CBD) [mouse equivalent dose (MED) of 10 mg/kg of CBD] in CRCE delivered with sesame oil for three consecutive days followed by intraperitoneally (i.p.) acetaminophen (APAP) administration (400 mg/kg) on day 4 resulted in overt toxicity with 37.5% mortality. No mortality was observed in mice treated with 290 mg/kg of CBD+APAP (MED of 25 mg/kg of CBD) or APAP alone. Following CRCE/APAP co-administration, microscopic examination revealed a sinusoidal obstruction syndrome-like liver injury–the severity of which correlated with the degree of alterations in physiological and clinical biochemistry end points. Mechanistically, glutathione depletion and oxidative stress were observed between the APAP-only and co-administration groups, but co-administration resulted in much greater activation of c-Jun N-terminal kinase (JNK). Strikingly, these effects were not observed in mice gavaged with 290 mg/kg CBD in CRCE followed by APAP administration. These findings highlight the potential for CBD/drug interactions, and reveal an interesting paradoxical effect of CBD/APAP-induced hepatotoxicity.

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Leberschaden unter oraler Antikoagulation, Statin- und ACE-Hemmertherapie

Praxis ◽

10.1024/1661-8157/a000298 ◽

2010 ◽

Vol 99 (21) ◽

pp. 1259-1265 ◽

Cited By ~ 2

Author(s):

Bruggisser ◽

Terraciano ◽

Rätz Bravo ◽

Haschke

Keyword(s):

Liver Injury ◽

Wird Eine ◽

Drug Induced ◽

Drug Induced Liver Injury

Ein 71-jähriger Patient stellt sich mit Epistaxis und ikterischen Skleren auf der Notfallstation vor. Der Patient steht unter einer Therapie mit Phenprocoumon, Atorvastatin und Perindopril. Anamnestisch besteht ein langjähriger Alkoholabusus. Laborchemisch werden massiv erhöhte Leberwerte (ALAT, Bilirubin) gesehen. Der INR ist unter oraler Antikoagulation und bei akuter Leberinsuffizienz >12. Die weiterführenden Abklärungen schliessen eine Virushepatitis und eine Autoimmunhepatitis aus. Nachdem eine Leberbiopsie durchgeführt werden kann, wird eine medikamentös-toxische Hepatitis, ausgelöst durch die Komedikation von Atorvastatin, Phenprocoumon und Perindopril bei durch Alkohol bereits vorgeschädigter Leber diagnostiziert. Epidemiologie, Pathophysiologie und Klink der medikamentös induzierten Leberschäden (drug induced liver injury, DILI), speziell von Coumarinen, Statinen und ACE-Hemmern werden im Anschluss an den Fallbericht diskutiert.

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