Complex liver injury induced by combined Aloe Vera and vitamin A oral supplements, as assessed by histology and the updated RUCAM-Reference-Cited by-同舟云学术

Complex liver injury induced by combined Aloe Vera and vitamin A oral supplements, as assessed by histology and the updated RUCAM

Published:2022-04-24 Issue: Volume: Page:181-187
ISSN:2692-3106
Container-title:Exploration of Medicine
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Author:

Delladetsima Katerina¹,Manesis Emanuel²,Tiniakos Dina³^ORCID,Sakellariou Stratigoula⁴^ORCID

Affiliation:

1. 2nd Department of Surgery, Army Share Fund Hospital, 11521 Athens, Greece

2. Liver Unit, Euroclinic, 11521 Athens, Greece

3. Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, NE2 4HH Newcastle upon Tyne, UK

4. 1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece

Abstract

A case of combined acute and chronic liver injury related to consumption of multi-ingredient nutritional oral supplements containing Aloe Vera gel and vitamin A among other vitamins, minerals and dietary elements such as fish and calamari oil in a 59-year-old female with unexplained hypertransaminasemia is reported. A unique complex liver injury was diagnosed on liver biopsy combining histological features of protracted acute hepatitis, mild manifestation of hypervitaminosis A and lipogranulomatous reaction attributed to Aloe Vera, vitamin A and lipids, respectively. Normalization of liver tests was achieved after discontinuation of all nutritional supplements. Updated Roussel Uclaf Causality Assessment Method (RUCAM) score (+8, probable) further supported herb-induced liver injury. The present case highlights the increasing incidence of complex histological liver injury linked to the constantly growing consumption of multi-ingredient dietary supplements and alternative medications.

Publisher

Open Exploration Publishing

Subject

General Medicine

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