Supplement Gone Wrong: Drug-Induced Liver Injury Caused by Artemisinin
American Journal of Gastroenterology
; 117(10 Supplement 2):S2026-S2027, 2022.
Article
in English
| EMBASE | ID: covidwho-2324488
ABSTRACT
Introduction:
Drug-induced liver injury (DILI) is defined as hepatic dysfunction caused by prescription medications, supplements, or xenobiotics after alternative causes have been excluded. As one of the leading causes of acute liver failure, DILI should be considered when patients present with hepatic dysfunction. We present a case of symptomatic DILI secondary to artemisinin use. Case Description/Methods:
A 78-year-old Chinese man with no medical history presented to the hepatology clinic with 10 weeks of jaundice, weakness, and pruritis. He started taking Artemisinin/ Bioperine 12 weeks ago to prevent COVID-19 but stopped 3 weeks ago. He denied abdominal pain, a family history of liver disease, substance/alcohol use, and taking other concomitant drugs. Physical examination revealed scleral icterus and no other signs of chronic liver disease. Laboratory studies showed total bilirubin 11 mg/dL, alkaline phosphatase 293 U/L, aspartate transaminase 170 U/L, and alanine transaminase 196 U/L with negative workup for hepatitis A, B, and C. CT abdomen and MRCP were unremarkable for liver or biliary pathology. Further serological workup was negative and follow-up labs revealed normalization of liver enzymes and bilirubin. Given the patient's improvement, liver biopsy was not pursued. The patient was instructed to avoid supplements unless prescribed by a physician. Discussion(s) DILI is a global issue with an estimated annual incidence rate of 13.9 to 24.0 per 100,000 persons. Diagnosing DILI is important as it can cause acute liver injury and liver failure in certain cases. Since COVID-19 emerged, supplement use has increased given claims of boosting the immune system. Artemisinin is an herb used in traditional Chinese medicine with antimalarial activity investigated to be a possible COVID-19 treatment, but no current evidence exists to support it being effective against COVID-193. Our patient's supplement also contained Bioperine, a black pepper extract, which is likely benign. Contrarily, artemisinin is a well-described cause of idiosyncratic acute liver injury and hepatotoxicity, causing self-limited mild to moderate transaminitis but also severe cases requiring emergent livertransplantation. Our patient's unrevealing workup, his spontaneous improvement correlating with supplement discontinuation, and RUCAM score of 7 led to high suspicion of DILI secondary to artemisinin. Providers should always ask patients about supplement use and consider DILI when patients present with liver injury. (Table Presented).
abdominal pain; acute liver failure; adverse drug reaction; aged; alanine aminotransferase blood level; alcohol consumption; antimalarial activity; biliary tract disease; Chinese; Chinese medicine; chronic liver disease; conference abstract; coronavirus disease 2019; drug withdrawal; drug-induced liver injury; family history; follow up; hepatitis A; human; hypertransaminasemia; immune system; incidence; jaundice; liver biopsy; liver disease; liver dysfunction; liver failure; liver injury; liver toxicity; major clinical study; male; medical history; physical examination; physician; prevention; pruritus; sclera; side effect; weakness; alanine aminotransferase; alkaline phosphatase; artemisinin; aspartate aminotransferase; bilirubin; black pepper extract; endogenous compound; liver enzyme
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Topics:
Traditional medicine
Language:
English
Journal:
American Journal of Gastroenterology
Year:
2022
Document Type:
Article
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