A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature

Abstract

A case of severe drug-induced liver injury caused by over the counter (OTC) herb medicine, is reported here. A 40-year-old male took herb drugs "Za ga-doKowa®," "Ohta-Isan®." These two drugs contained the same two herb medicines (cinnamon, fennel). About 4 months later after taking medicine, jaundice appeared. Prothrombin time activation (PT) was 45%, aspartate transaminase (AST) was 1104 IU/l, and total bilirubin (T-bil) 14.7 mg/dL. Serum tests for hepatitis viruses (A, B, C, E) were negative. Lymphocyte stimulating test was positive for Za ga-do Kowa ® and Ohta-I Isan®. Liver 3D constructed by construct-CT revealed findings of the potato-like liver. The liver biopsy specimen revealed multilobular hepatic necrosis accompanied by scar formation, severe zonal degeneration and necrosis of hepatocytes mainly in the central area of the lobule. In the reported 13 cases of cinnamon-induced liver diseases, there has been a severe abnormality of PT and T-bil. Biopsy findings of these cases showed wide ranges of necrosis. Liver injury due to cinnamon shows very severe damages, and the possibility of liver failure due to cinnamon may be imminent. How to cite this article: Higaki H, Onji M, Takeji S, Uehara T, Kawasaki K, Kashimoto Y, Murakami T, Yamaguchi T, Miyaike J, Oomoto M, Abe M. A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature. Euroasian J Hepatogastroenterol, 2018;8(2):167-171.

Keywords: Cinnamon; Drug-induced liver injury; Herb medicine; Over-the-counter; Severe hepatitis..

Fig. 1:

Volume rendering imaging of the liver showing a potato liver. It is the liver on the 51st day after hospitalization. Volume rendering image (Liver 3D construction image by Vincent) revealed the irregular atrophy at the liver interior ~ anterior compartment and potato-like regrowth

Figs 2A to C:

(A) Liver biopsy specimen showing inflammatory cell infiltration withy relatively high proportions of lymphocytes (small number of eosinophils and neutrophils); (B and C) There were partially bridging necrosis and fibrosis in liver bJiopsy specimen.