Herbal Drugs: Friend or Foe?

Abstract

We herein report a rather peculiar case of acute liver injury. A 78-year-old woman developed asthenia and weakness. Her previous medical history was irrelevant, except for having received etoricoxib 60mg/24h for osteoarthritis 1 month before. Liver biochemistry indicated hepatic failure; all tests for viral, bacterial, or parasitic infections were negative, as were the autoimmunity tests. As the patient's status gradually declined, a transjugular hepatic biopsy was obtained and confirmed hepatocyte necrosis with severe inflammation and presence of numerous eosinophils. Suspecting a potential toxic cause of the disorder, the patient was requestioned and admitted curcuma consumption for a long time. She was asked to discontinue it and her status gradually improved, with normalization of all the analytical parameters. On the long-term follow-up, she remains well. We consider that this case of acute liver injury can be explained with the combination of the acute toxic effect of a drug, etoricoxib, and the herbal remedy curcuma. This case is illustrative of the risk of interactions between drugs and natural remedies, and to the best of our knowledge, it is the first case of severe hepatotoxicity related to etoricoxib, probably potentiated by long-term curcumin intake. Besides, it illustrates the fact that patients do not generally consider natural remedies as potential source of toxicity, and this can lead to a delay in diagnosis.