The Silent Risk in ‘Natural’ Health Products

Abstract

Amith Siripurapu* and Suresh Kankanala

Drug induced liver injury (DILI) is a rapid loss of hepatic function in a person and is clinically diagnosed by jaundice and elevated liver enzymes; It is caused by hepatotoxic medications such as acetaminophen. This case report is of a patient who is a 60 year female with a history of positive ANA who presents the clinic with jaundice and full body pruritic rashes. She has been to urgent care twice in the last couple of months where medrol dose packs and injections were given. She admits this helps, but symptoms resume once the steroid course is completed. Laboratory evaluation showed cholestasis with elevations in alkaline phosphatase (911 U/L), total bilirubin (6.2 mg/dL), and alongside macrocytosis (MCV 106.8 fL). Despite positive autoimmune markers (ANA/AMA 1:160) which initially raised concern for autoimmune etiology, a liver biopsy confirmed DILI. Further interrogation revealed that she is taking several herbal supplements and protein powder, which were discontinued. Most recent visit to the office her symptoms improved but liver function tests were still abnormal and currently being monitored in consultation with Hepatology. This case highlights the critical importance of obtaining a comprehensive medication history that includes unregulated herbal supplements which can contribute to potential health hazards.

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