Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea
Background:Artemisia annua is a Chinese medicinal herb. Artemisinin-derivatives are recommended as part of a combination treatment for uncomplicated malaria. Herbal and dietary supplements (HDS) are increasingly used worldwide and HDS-induced liver injury is becoming a growing concern.Case Report: W...
Main Authors: | , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2019-10-01
|
Series: | Frontiers in Medicine |
Subjects: | |
Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2019.00221/full |
id |
doaj-4cb0e153ea8b4a349cf92f722575089f |
---|---|
record_format |
Article |
spelling |
doaj-4cb0e153ea8b4a349cf92f722575089f2020-11-25T02:03:11ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2019-10-01610.3389/fmed.2019.00221478536Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua TeaFrancisco Javier Ruperti-Repilado0Simon Haefliger1Sophia Rehm2Markus Zweier3Katharina M. Rentsch4Johannes Blum5Alexander Jetter6Markus Heim7Anne Leuppi-Taegtmeyer8Luigi Terracciano9Christine Bernsmeier10University Center for Gastrointestinal and Liver Diseases, Basel, SwitzerlandInstitute of Pathology, University Hospital Basel, Basel, SwitzerlandDepartment of Laboratory Medicine, University Hospital Basel, Basel, SwitzerlandInstitute of Medical Genetics, University of Zurich, Zurich, SwitzerlandDepartment of Laboratory Medicine, University Hospital Basel, Basel, SwitzerlandSwiss Tropical and Public Health Institute, Basel, SwitzerlandDepartment of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandUniversity Center for Gastrointestinal and Liver Diseases, Basel, SwitzerlandDivision of Clinical Pharmacology and Toxicology, Department of Medicine, University Hospital Basel, Basel, SwitzerlandInstitute of Pathology, University Hospital Basel, Basel, SwitzerlandUniversity Center for Gastrointestinal and Liver Diseases, Basel, SwitzerlandBackground:Artemisia annua is a Chinese medicinal herb. Artemisinin-derivatives are recommended as part of a combination treatment for uncomplicated malaria. Herbal and dietary supplements (HDS) are increasingly used worldwide and HDS-induced liver injury is becoming a growing concern.Case Report: We present the first case of severe acute cholestatic hepatitis due to the intake of Artemisia annua tea as chemoprophylaxis for malaria in a patient returning from Ethiopia. The patients presented with jaundice, elevated transaminases, and parameters of cholestasis (total bilirubin 186.6 μmol/L, conjugated bilirubin 168.5 μmol/L). A liver biopsy showed a portal hepatitis with lymphocytic infiltration of the bile ducts and diffuse intra-canalicular and intra-cytoplasmic bilirubinostasis. The toxicologic analysis of the Artemisia tea revealed the ingredients arteannuin b, deoxyartemisin, campher, and scopoletin. There were no other identifiable etiologies of liver disease. The Roussel Uclaf Causality Assessment Method (RUCAM) score assessed a “probably” causal relationship. Sequencing of genes encoding for hepatic transporters for bile acid homeostasis (BSEP, MDR3, and FIC1) found no genetic variants typically associated with hereditary cholestasis syndromes. Normalization of bilirubin occurred 3 months after the onset of disease.Conclusion: The use of artemisinin-derivatives for malaria prevention is ineffective and potentially harmful and should thus be discouraged. Moreover, the case demonstrates our as yet inadequate understanding of the pathophysiology and susceptibility to HDS induced liver injury.https://www.frontiersin.org/article/10.3389/fmed.2019.00221/fullacutecholestatic liver diseasedrug induced liver injuryArtemisia annua teaartemisininherbal and dietary supplement |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Francisco Javier Ruperti-Repilado Simon Haefliger Sophia Rehm Markus Zweier Katharina M. Rentsch Johannes Blum Alexander Jetter Markus Heim Anne Leuppi-Taegtmeyer Luigi Terracciano Christine Bernsmeier |
spellingShingle |
Francisco Javier Ruperti-Repilado Simon Haefliger Sophia Rehm Markus Zweier Katharina M. Rentsch Johannes Blum Alexander Jetter Markus Heim Anne Leuppi-Taegtmeyer Luigi Terracciano Christine Bernsmeier Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea Frontiers in Medicine acute cholestatic liver disease drug induced liver injury Artemisia annua tea artemisinin herbal and dietary supplement |
author_facet |
Francisco Javier Ruperti-Repilado Simon Haefliger Sophia Rehm Markus Zweier Katharina M. Rentsch Johannes Blum Alexander Jetter Markus Heim Anne Leuppi-Taegtmeyer Luigi Terracciano Christine Bernsmeier |
author_sort |
Francisco Javier Ruperti-Repilado |
title |
Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea |
title_short |
Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea |
title_full |
Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea |
title_fullStr |
Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea |
title_full_unstemmed |
Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea |
title_sort |
danger of herbal tea: a case of acute cholestatic hepatitis due to artemisia annua tea |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2019-10-01 |
description |
Background:Artemisia annua is a Chinese medicinal herb. Artemisinin-derivatives are recommended as part of a combination treatment for uncomplicated malaria. Herbal and dietary supplements (HDS) are increasingly used worldwide and HDS-induced liver injury is becoming a growing concern.Case Report: We present the first case of severe acute cholestatic hepatitis due to the intake of Artemisia annua tea as chemoprophylaxis for malaria in a patient returning from Ethiopia. The patients presented with jaundice, elevated transaminases, and parameters of cholestasis (total bilirubin 186.6 μmol/L, conjugated bilirubin 168.5 μmol/L). A liver biopsy showed a portal hepatitis with lymphocytic infiltration of the bile ducts and diffuse intra-canalicular and intra-cytoplasmic bilirubinostasis. The toxicologic analysis of the Artemisia tea revealed the ingredients arteannuin b, deoxyartemisin, campher, and scopoletin. There were no other identifiable etiologies of liver disease. The Roussel Uclaf Causality Assessment Method (RUCAM) score assessed a “probably” causal relationship. Sequencing of genes encoding for hepatic transporters for bile acid homeostasis (BSEP, MDR3, and FIC1) found no genetic variants typically associated with hereditary cholestasis syndromes. Normalization of bilirubin occurred 3 months after the onset of disease.Conclusion: The use of artemisinin-derivatives for malaria prevention is ineffective and potentially harmful and should thus be discouraged. Moreover, the case demonstrates our as yet inadequate understanding of the pathophysiology and susceptibility to HDS induced liver injury. |
topic |
acute cholestatic liver disease drug induced liver injury Artemisia annua tea artemisinin herbal and dietary supplement |
url |
https://www.frontiersin.org/article/10.3389/fmed.2019.00221/full |
work_keys_str_mv |
AT franciscojavierrupertirepilado dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT simonhaefliger dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT sophiarehm dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT markuszweier dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT katharinamrentsch dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT johannesblum dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT alexanderjetter dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT markusheim dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT anneleuppitaegtmeyer dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT luigiterracciano dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea AT christinebernsmeier dangerofherbalteaacaseofacutecholestatichepatitisduetoartemisiaannuatea |
_version_ |
1724948941276971008 |