A Sinister Cause of Extreme Hepatitis

Abstract

Background and Aim: Acute liver injury/failure is a life threatening medical emergency which if promptly recognized and managed can be life saving. History of drugs and dietary supplements including herbals is of paramount importance in the management of acute liver injury as they are potentially avertible. Here we report one such case of acute liver injury. Methods: A 35-year-old male presented to Gastroenterology OPD with anorexia, nausea, vomiting for 3 days. Apart from mild icterus, rest of the general and systemic examination was unremarkable. His initial liver function tests showed acute hepatitis pattern. He denied any history of habits and his past history was significant for diabetes of 2 yrs duration. Various other causes of liver disease including acute viral hepatitis (A,B,C,E), Wilson's disease and autoimmune hepatitis were ruled out by relevant investigations. Careful history review revealed he was taking green tea extract for 7 days prior to the onset of symptoms, which was stopped since then. In view of coagulopathy, he underwent transjugular liver biopsy, which showed hepatocyte disarray with feathery degeneration, micro and macrovescicular steatosis, pseudo glandular and giant cell transformation, spotty necrosis with acidophil bodies. He was treated with N-Acetyl Cysteine, insulin basal bolus regime and UDCA. Results: There was improvement in liver function parameters with bilirubin trending down up to 1.3 and INR to 1.2. This case demonstrates a rare cause of acute liver injury (Table 1).Table 1Liver Function Tests.DateT. Bil mg/dlD. Bil mg/dlAST IU/mlALT IU/mlPT/INR16/01/173.72.37538911523.2/2.0619/01/179.358.21928520826.4/2/3420/1/1710.518.563491469925.6/2.2721/01/1710.678.092568449424.1/2.1423/01/179.458.22528231416.8/1.4924/01/1710.058.6268169416.0/1.4227/01/1713.0710.5910566115.2/1.35 Open table in a new tab Conclusion: Though rare, green tea extracts can potentially lead to severe acute liver injury and probably acute liver failure if unaddressed. In the present era of increasing usage of herbal and dietary supplements for health benefits/weight loss patients and physicians should become more aware regarding the hepatotoxicity of GTE/HDS. Clinical history still plays a vital role in identifying offending agent and avoiding unnecessary management in idiopathic acute liver injury/failure (Figure 1). The authors have none to declare.