Liver Injury after Consumption of High Dose Tahitian Noni Juice

Abstract

Purpose: Noni juice is a popular complimentary alternative medication often consumed for its wellness effects and is recommended for consumption at a dose of 1 oz (30 ml) per day. To our knowledge this is the first reported case of idiosyncratic drug induced liver injury (DILI) from United States that occurred after high dose consumption of Noni juice. Methods: A 49 -year-old African American female with underlying liver disease presented with new onset jaundice. She had history of chronic consumption of Noni juice for several years at the recommended dose. However, two months prior to the presentation she had increased her daily consumption to 8 oz. Six weeks after increasing her dose, she developed mild constitutional symptoms eventually progressing to fatigue and jaundice. Results: Her workup revealed elevated liver tests (ALP 247, AST 365, ALT 145 and total bilirubin 3.9 gm/dL), negative titers for viral and autoimmune hepatitis and imaging studies significant only for fatty infiltration of liver. She gave a history of occasional alcohol and acetaminophen use (4–6 grams/day). She had no exposure to any other xenobiotics. Extensive biochemical work up performed excluded all competing etiologies. Upon discontinuation of consumption of Noni juice at the onset of her jaundice, she had normalization of her liver tests over a period of 4 months. She did not receive any therapy with steroids. Conclusion: This is the first reported case of idiosyncratic DILI after exposure to Noni juice from the United States. While a few cases reported from Europe showed a hepatocellular pattern of injury, this case presented with a cholestatic pattern of liver injury. The potential for toxicity caused by noni juices remains under surveillance by the food safety authorities in Europe currently and physicians in United States should be aware of this possibility.Figure: Liver test trend during recovery period.