Herbal Detox Tea: A Potential Cause of Acute Liver Failure

Abstract

We present a case of acute fulminant liver failure from a liver detoxification tea containing multiple herbal ingredients marketed to be hepato-protective.The patient was a 60 year-old Caucasian female who presented with a new onset of generalized weakness, lethargy, scleral icterus, and jaundice that worsened over two weeks. She reported drinking herbal tea three times a day for 14 days prior to symptom development to improve her health. The herbal compound used was a detoxification tea purchased at a chain grocery store. On admission, physical exam showed jaundice and scleral icterus. Patient became progressively lethargic and developed asterixis. Her lethargy progressed to somnolence requiring intubation. She was placed on the transplant list on day 15 and passed away on day 17. Initial labs included: aspartate aminotransferase (AST) 450 U/L, alanine aminotransferase (ALT) 583 U/L, alkaline phosphatase 202 U/L, and bilirubin 21.8 mg/dl. ALT, AST, and ALP trended down during admission but bilirubin continued to rise to 43.49 mg/dl. Extensive lab work ordered to determine the etiology of her liver failure was negative. An ultrasound guided liver biopsy showed submassive necrosis with portal, periportal and panlobular inflammation, hepatocyte ballooning, mallory hyaline and single cell apoptosis (Figure 1). Her liver histology was consistent with previously published reports of medication induced liver injury. Her liver necrosis can most likely be attributed to her ingestion of this herbal supplement.The literature search on the ingredients in Pubmed shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. This case adds to the growing concern over the safety of certain herbal products and serves to heighten healthcare provider awareness of herbal tea hepatotoxicity.Figure 1