Severe Liver and Renal Injury From Tribulus Terrestris

Tribulus terrestris is a shrub that is found worldwide. Although it has been linked to severe jaundice and death in grazing animals, there are only a few case reports of hepatotoxicity in humans. We describe a case of a 46-year-old man who took tribulus supplements daily for 2 months. He developed severe jaundice prompting hospital admission. His total bilirubin peaked at 48 mg/dL, with concomitant renal dysfunction (creatinine of 7.1). His liver biopsy showed features consistent with drug-induced liver injury. He was initiated on a trial of plasmapheresis and underwent 3 sessions with a subsequent decrease in bilirubin with each session. He had appropriate renal recovery and was discharged home and on follow-up, continues to do well with most recent bilirubin of 1.1 mg/dL.