Hepatotoxicity From Marijuana Gummies
American Journal of Gastroenterology
; 117(10 Supplement 2):S1954, 2022.
Article
in English
| EMBASE | ID: covidwho-2322001
ABSTRACT
Introduction:
We report a case of drug-induced liver injury (DILI) induced by cannabis gummies containing Corydalis Rhizome. Case Description/Methods:
A 37-year-old female presented to her primary care clinic with recurrent fevers, night sweats, and myalgias for 7 weeks accompanied by eye redness, brain fog, headache, nausea, and abdominal pain. She denied rashes, tick-bites, cough, dyspnea, chest pain, joint swelling, or genitourinary symptoms. Past medical history was notable for IBS, migraines, and anxiety. She reported edible marijuana use four times a week, rare alcohol use, and denied tobacco use. She denied a family history of liver disease. Physical exam was notable for tachycardia to 110 and scleral injection with the remainder of vitals and exam unremarkable. Initial labs were notable for AST 61, ALT 44 and CRP of 12. CBC, BMP, urinalysis, ESR, blood cultures, blood smear for parasite screen, tests for Lyme disease, Babesia, Tularemia, Anaplasma, Ehrlichia, Rickettsia, EBV, HIV, RPR, ANA, CMV, parvovirus B19, and chest x-ray were all negative. The patient was referred to infectious disease with further testing for West Nile, Leptospira, lymphocytic choriomeningitis virus, and COVID-19 returning negative. Repeat LFTs showed worsening transaminitis with ALT 979 and AST 712, alkaline phosphatase 88, total bilirubin 0.7, and albumin 4.9. Hepatitis workup including hepatitis A, B, and C, HSV, EBV, VZV serologies, AMA, ASMA, antiLKM Ab, acetaminophen level, INR, iron panel, CPK, TSH, and abdominal ultrasound were all normal. It was later discovered that her marijuana gummies contained Corydalis rhizome extract known to be hepatotoxic. Cessation of this drug was strongly advised. She was discharged with hepatology follow-up and underwent a liver biopsy showing patchy periportal and lobular inflammation with extension across the limiting plate, hepatocyte injury and apoptosis, and increased lipofuscin for age compatible with mild to moderate hepatitis. She had complete recovery after cessation of Corydalis-containing gummies. (Figure)Discussion:
Our patient consumed '1906 Midnight', an American cannabis brand containing Corydalis rhizopus 100 mg, advertised to improve sleep, pain, and have a liver protective effect. A Korean systematic review on herbal-induced liver injury reported that Corydalis was the 3rd most frequent causative herb, with 36 cases. Although there are several personal accounts on social networking sites and other websites, there are no American-based publications reported on DILI from Corydalis. (Table Presented).
abdominal pain; adult; adverse drug reaction; alanine aminotransferase blood level; alcohol consumption; Anaplasma; anxiety; apoptosis; aspartate aminotransferase level; Babesia; blood culture; blood smear; cannabis use; clouding of consciousness; communicable disease; conference abstract; coronavirus disease 2019; Corydalis; coughing; drug-induced liver injury; dyspnea; Ehrlichia; eye redness; family history; female; follow up; headache; hepatitis A; human; Human immunodeficiency virus; Human parvovirus B19; hypertransaminasemia; inflammation; international normalized ratio; joint swelling; Leptospira; liver biopsy; liver cell damage; liver disease; liver injury; liver toxicity; Lyme disease; Lymphocytic choriomeningitis virus; medical history; migraine; myalgia; nausea; night sweat; nonhuman; parasite; physical examination; primary medical care; recurrent fever; rhizome; Rhizopus; Rickettsia; sclera; serology; side effect; social media; systematic review; tachycardia; thorax pain; thorax radiography; tick bite; tobacco use; tularemia; ultrasound; urinalysis; Varicella zoster virus; albumin; alkaline phosphatase; bilirubin; cannabis; endogenous compound; iron; lipofuscin; paracetamol; plant extract; thyrotropin
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Cohort study
/
Prognostic study
/
Reviews
/
Systematic review/Meta Analysis
Topics:
Traditional medicine
Language:
English
Journal:
American Journal of Gastroenterology
Year:
2022
Document Type:
Article
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