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A Case of Supplement-Induced Hepatitis
Carolina M Pusec1,2, Ryan Wolsky1, Christopher Llerena1,2
1Internal Medicine, Advocate Christ Medical Center, Oak Lawn, USA.
Cureus
|November 21, 2022
Summary
Acute hepatitis is rare but possible with herbal supplement use. High-dose ashwagandha, combined with alcohol and other medications, may cause acute steatohepatitis.
Area of Science:
- Hepatology
- Toxicology
- Integrative Medicine
Background:
- Herbal supplements are widely used, but their potential for hepatotoxicity is not always recognized.
- Drug-induced liver injury (DILI) can arise from various substances, including natural products.
- Concurrent use of alcohol and multiple medications can increase the risk of adverse liver events.
Observation:
- A case of acute steatohepatitis is presented.
- The patient chronically consumed high doses of ashwagandha and other herbal supplements.
- The patient also had a history of alcohol use and was on a multi-medication regimen.
Findings:
- Acute steatohepatitis developed in the patient.
- The clinical presentation suggests a potential link between high-dose ashwagandha, other herbal supplements, alcohol, and polypharmacy and the observed liver injury.
- This case highlights the importance of considering herbal supplement-induced liver injury in differential diagnoses.
Implications:
- Healthcare providers should inquire about herbal supplement use in patients presenting with acute hepatitis.
- Further research is needed to elucidate the specific hepatotoxic mechanisms of ashwagandha and other widely used herbal supplements.
- Clinicians must carefully assess the cumulative risk of hepatotoxicity when patients use multiple substances, including alcohol, medications, and herbal products.
