Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb

Abstract Background Drug induced liver injury (DILI) is an important cause of acute liver injury and accounts for approximately 10% of all cases of acute hepatitis. Both prescription and natural health products (NHPs) have been implicated in DILI. There is a dearth of studies on NHPs induced liver injury. Case Presentation A previously healthy 37-year-old female presented with subacute hepatitis, in the context of a previous admission to a separate institution, months prior for undiagnosed acute hepatitis. Importantly, she had disclosed taking complex regiments of natural health products (NHPs) for months. Her only other medication was rivaroxaban for her homozygous Factor V Leiden deficiency. She had an extensive work up for causes of acute and unresolving hepatitis. She discontinued several but not all of her NHPs after her initial presentation for acute hepatitis at the first institution and continued taking NHPs until shortly after admission to our institution. The predominant pathological features were that of drug induced liver injury, although an abnormal amount of copper was noted in the core liver biopsies. However, Wilson’s disease was ruled out with normal serum ceruloplasmin and 24-urine copper. After 2 months of stopping all the NHPs, our patient improved significantly since discharge, although there is evidence of fibrosis on ultrasound at last available follow up. Conclusion NHPs are a well-established but poorly understood etiology of DILI. The situation is exacerbated by the unregulated and unpredictable nature of many of the potential hepatotoxic effects of these agents, especially in cases of multiple potential toxic agents. This highlights the importance of acquiring a clear history of all medications regardless of prescription status.

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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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A case of acute hepatitis E virus infection with clinical features indistinguishable from drug-induced liver injury

Kanzo ◽

10.2957/kanzo.46.512 ◽

2005 ◽

Vol 46 (8) ◽

pp. 512-515 ◽

Cited By ~ 7

Author(s):

Masaya IWAMURO ◽

Mitsuhiko KAWAGUCHI ◽

Ryo TERADA ◽

Toshiya OHSAWA ◽

Kazuhide YAMAMOTO ◽

...

Keyword(s):

Liver Injury ◽

Virus Infection ◽

Acute Hepatitis ◽

Clinical Features ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Acute Hepatitis E

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Metabolomics Profiling and Diagnosis Biomarkers Searching for Drug-Induced Liver Injury Implicated to Polygonum multiflorum: A Cross-Sectional Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2020.592434 ◽

2020 ◽

Vol 7 ◽

Author(s):

Ying Huang ◽

Xu Zhao ◽

Zi-teng Zhang ◽

Shuai-shuai Chen ◽

Shan-shan Li ◽

...

Keyword(s):

Liver Injury ◽

Decision Tree ◽

High Efficiency ◽

High Resolution Mass Spectrometry ◽

Classification Model ◽

Plasma Metabolites ◽

Polygonum Multiflorum ◽

Drug Induced ◽

Cross Sectional ◽

Drug Induced Liver Injury

Aim: The diagnosis of drug-induced liver injury (DILI) remains a challenge and the cases of Polygonum multiflorum Thunb. (PM) induced DILI (PM-DILI) have received much attention This study aimed to identify a simple and high-efficiency approach to PM-DILI diagnosis via metabolomics analysis.Methods: Plasma metabolites in 13 PM-DILI patients were profiled by liquid chromatography along with high-resolution mass spectrometry. Meanwhile, the metabolic characteristics of the PM-DILI were compared with that of autoimmune hepatitis (AIH), hepatitis B (HBV), and healthy volunteers.Results: Twenty-four metabolites were identified to present significantly different levels in PM-DILI patients compared with HBV and AIH groups. These metabolites were enriched into glucose, amino acids, and sphingolipids metabolisms. Among these essential metabolites, the ratios of P-cresol sulfate vs. phenylalanine and inosine vs. bilirubin were further selected using a stepwise decision tree to construct a classification model in order to differentiate PM-DILI from HBV and AIH. The model was highly effective with sensitivity of 92.3% and specificity of 88.9%.Conclusions: This study presents an integrated view of the metabolic features of PM-DILI induced by herbal medicine, and the four-metabolite decision tree technique imparts a potent tool in clinical diagnosis.

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Drug-induced liver injury: from pathogenesis to treatment

Herald of Pancreatic Club ◽

10.33149/vkp.2020.01.10 ◽

2020 ◽

Vol 46 (1) ◽

pp. 72-80

Author(s):

N. B. Gubergrits ◽

N. V. Byelyayeva ◽

A. Ye. Klochkov ◽

G. M. Lukashevich ◽

P. G. Fomenko

Keyword(s):

Liver Injury ◽

Acute Hepatitis ◽

Toxic Effect ◽

Drug Induced ◽

Pathological Effect ◽

Pharmacological Agents ◽

Drug Induced Liver Injury ◽

Practical Algorithm ◽

Liver Changes ◽

Drug Hepatitis

The article presents data on classification, pathogenesis, clinical picture, diagnosis and differentiated treatment tactics, as well as practical algorithm for recognizing and preventing the development of drug-induced liver injury. Pathogenesis of drug-induced liver injury is analyzed, mechanisms of drug metabolism are explained, metabolism phases are described. Four main mechanisms of the pathological effect of drugs on the liver are identified: direct toxic effect on hepatocytes; toxic effect of drug metabolites; immunoallergic liver injury; idiosyncrasy. Peculiar attention is paid to the pathogenesis of drug-induced cholestasis. Direct hepatotoxic reactions develop according to the cytolytic (hepatocellular, parenchymal), cholestatic or mixed option. The most commonly diagnosed clinical variant of drug-induced liver injury is drug-induced hepatitis. Five forms of hepatitis induced by the use of pharmacological agents are distinguished: drug-induced hepatitis with an isolated increase in transaminases (anti-TB drugs, methyldopa, amiodarone, statins); acute hepatitis with jaundice; pseudo-surgical form of acute hepatitis: abdominal pain, fever, jaundice, enlarged gall bladder (cytostatics, antidepressants, antiarrhythmic drugs); severe forms of acute hepatitis with liver failure; chronic drug hepatitis. International diagnostic criteria, basic data on morphological liver changes are presented. Action of ursodeoxycholic acid is explained. It has a litholytic, anticholestatic, cytoprotective, immunomodulating, anti-inflammatory, antitoxic, hypocholesterolemic effect, modulates apoptosis, has a differentiated effect on the regeneration of hepatocytes.

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