Fulminant Exacerbation of Autoimmune Hepatitis After the Use of Ma Huang

Borum, Marie

doi:10.1111/j.1572-0241.2001.03827.x

Cited by 61 publications

(23 citation statements)

References 3 publications

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“…Ephedra has been thought to be the cause of hepatotoxicity in LipoKinetix TM by some (4), although reports in the literature are controversial. There are two reports of severe acute liver failure possibly related to Ma Huang (14,15). In both cases, the patients developed acute liver failure but also had a positive nuclear and smooth muscle antibody.…”

Section: Discussionmentioning

confidence: 99%

Fulminant Liver Failure Due to Usnic Acid for Weight Loss

Durazo

Lassman

Han

et al. 2004

Am J Gastroenterology

102

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The use of complementary and alternative medicine (CAM) in developed countries has increased significantly over the years. Among the most popular are the weight loss supplements or "fat burners." Liver failure due to these popular remedies has been widely recognized. Usnic acid has been an ingredient of dietary supplements that cause liver failure. Its hepatotoxicity has not been recognized because it is usually mixed with other ingredients that are presumably hepatotoxic. We describe a case of a 28-yr-old woman who presented with fulminant liver failure requiring orthotopic liver transplantation, after taking pure usnic acid for weight loss. This is the first report on fulminant liver failure associated with the ingestion of pure usnic acid. A discussion about hepatotoxicity of the different compounds of dietary supplements is presented. This is a reminder for the clinicians about the potential side effects of CAM.

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Section: Discussionmentioning

confidence: 99%

Fulminant Liver Failure Due to Usnic Acid for Weight Loss

Durazo

Lassman

Han

et al. 2004

Am J Gastroenterology

102

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“…Drugs that have been implicated in less than five reports are benzarone [66], diclofenac [67], fenofibrate [68], meloxicam [69], methylphenidate [70], papaverine [71], pemoline [72], propylthiouracil [73,74], prometrium [27], cephalexin [27], atorvastatin [75][76][77][78], rosuvastatin [79], phenprocoumon [80], terbinafine [81], indometacin [82], imatinib [83], infliximab [84][85][86], and adalimumab [87,88]. Nutritional supplements (hydroxycut) [89], herbal medicines (dai-saiko-to, black cohosh, ma huang, germander) [90][91][92][93][94][95], and an environmental pollutant (trichloroethylene) [96] complement the list of agents that have a weak, uncertain, or rare association with an autoimmunelike hepatitis (Table 1).…”

Section: Etiological Candidates For Drug-induced Autoimmunelike Hepatmentioning

confidence: 99%

Drug-Induced Autoimmune-Like Hepatitis

2011

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The clinical phenotype of classical autoimmune hepatitis can be mimicked by idiosyncratic drug-induced liver injury, and differentiation can be difficult. The goals of this review are to enumerate the major agents of drug-induced autoimmune-like hepatitis, describe the clinical findings and risk factors associated with it, detail the clinical tools by which to assess causality, discuss putative pathogenic mechanisms, and describe treatment and outcome. The frequency of drug-induced autoimmune-like hepatitis among patients with classical features of autoimmune hepatitis is 9%. Minocycline and nitrofurantoin are implicated in 90% of cases. Female predominance, acute onset, and absence of cirrhosis at presentation are important clinical manifestations. Genetic factors affecting phase I and phase II transformations of the drug, polymorphisms that protect against cellular oxidative stress, and human leukocyte antigens that modulate the immune response may be important pathogenic components. Clinical judgment is the mainstay of diagnosis as structured diagnostic methods for drug-induced liver injury are imperfect. The covalent binding of a reactive drug metabolite to a hepatocyte surface protein (commonly a phase I or phase II enzyme), formation of a neoantigen, activation of CD8 T lymphocytes with nonselective antigen receptors, and deficient immune regulatory mechanisms are the main bases for a transient loss of self-tolerance. Discontinuation of the offending drug is the essential treatment. Spontaneous improvement usually ensues within 1 month. Corticosteroid therapy is warranted for symptomatic severe disease, and it is almost invariably effective. Relapse after corticosteroid withdrawal probably does not occur, and its absence distinguishes drug-induced disease from classical autoimmune hepatitis.

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“…There are anecdotal reports of associations with many other drugs including ezetimibe,40 interferon β,41 42 ornidazole,43 diclofenac,44 indomethecin,45 terbinafine,46 methyldopa,47 ranitidine,48 atorvastatin,49 fluvastatin,50 fibrates,51 adalimubab52 and after hepatitis A vaccination 53. AIH has also been reported after herbal medicines 54 55. However, many of these associations may be coincidental.…”

Section: A Introductionmentioning

confidence: 99%

British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis

Gleeson

Heneghan

2011

Gut

249

336

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Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease which, if untreated, often leads to cirrhosis, liver failure and death. Major advances were made in its management based on controlled trials performed in England and the USA in the 1970s and 1980s. Unfortunately, in recent decades there has been a dearth of controlled clinical trials and, thus, many questions regarding the optimal management of this disease remain unanswered. Many promising newer immunosuppressive therapies await formal comparison with standard therapies and also many important details in relation to the application of standard therapies remain unclear. These guidelines describe the optimal management strategies in adults based on available published evidence, including the American Association for the Study of Liver Diseases practice guidelines for the diagnosis and treatment of AIH published in 2002 and recently updated.

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Fulminant Exacerbation of Autoimmune Hepatitis After the Use of Ma Huang

Cited by 61 publications

References 3 publications

Fulminant Liver Failure Due to Usnic Acid for Weight Loss

Fulminant Liver Failure Due to Usnic Acid for Weight Loss

Drug-Induced Autoimmune-Like Hepatitis

British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis

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