2406 Cinnamon-Induced Acute Hepatitis

Abstract

INTRODUCTION: There is no denying the increasing interest in alternative medical practices in the United States, especially in regards to supplement use. According to a recent survey, 33.2% of adults in the US used complementary health approaches, and 17.7% reported using a supplement. As the use of supplements rises, it is imperative that physicians recognize the potential adverse effects. One example of this is the popular practice of using cinnamon supplementation to improve glycemic control in Diabetes. However, less attention has been given to a potential adverse effect of cinnamon use. Coumarin is a compound found in cinnamon and its metabolite are hepatotoxic. Our patient presented with hepatitis triggered by the use of a seemingly innocent supplement. CASE DESCRIPTION/METHODS: A 51 year old male with a past medical history of hyperlipidemia presented with 10 days of right upper quadrant abdominal pain, jaundice and dark urine. He denies tobacco, alcohol, or illicit drug use. Home medications are aspirin and atorvastatin. Only new medication is cassia cinnamon supplements for the past month. Physical exam was significant for scleral icterus, jaundice, abdominal distention, and tenderness to palpation in the RUQ. Lab work revealed a CBC within normal limits, and elevated LFTs. Acute hepatitis panel, ANA, anti-smooth muscle antibody, anti-mitochondrial antibody, ferritin, HIV, HSV, EBV, and CMV were negative. An ultrasound of the abdomen was unremarkable. His atorvastatin and cinnamon supplements were held. An MRCP was obtained and was unremarkable. His symptoms and LFTs improved and he was discharged home after two days of hospitalization with instructions to hold the atorvastatin until his liver function tests normalized, and to discontinue the cassia cinnamon. The acute hepatitis was determined to be due to the cassia cinnamon supplementation with concomitant statin use. DISCUSSION: This case illustrates the importance of a thorough history when evaluating a patient. Special attention must be paid to over the-counter medications, herbs, and supplements. Often times patients will not volunteer this information when asked about what medications they take, so they must be specifically prompted. Given the increasing popularity of alternative and “natural” medical practices, it is also imperative that physicians stay up to date on the potential adverse effects. Emphasis needs to be placed on scientific investigation into potential risks and benefits of popular alternative medical practices.