Drug-induced, mixed-type hepatitis following ingestion of Cordyceps sinensis.

The use of herbal and dietary supplements is increasing worldwide. Consumers consider it as a natural, and therefore safe and healthy alternative to conventional synthetic drugs and do not expect adverse effects. However, numerous herbal and dietary supplements have been associated with adverse hepatic reactions of variable severity. Recognition of adverse hepatic reactions following the ingestion of herbal and dietary supplements is sometimes difficult since clinical presentation can resemble that of other etiologies unrelated to xenobiotics. Pharmacovigilance is based on spontaneous reporting and, thus, many incidents probably remain unrecorded due to lack of awareness among users and prescribers. The present report describes the first case of cholestatic hepatitis after the intake of an herbal supplement containing Cordyceps sinensis. Causality was considered probable after exclusion of alternative causes, a close temporal relationship, and an immediate dechallenge response with a full remission.

Drug-induced acute liver injury mimicking autoimmune hepatitis after intake of dietary supplements containing glucosamine and chondroitin sulfate.

INTRODUCTION: Herbal and dietary supplements are widely used as measures to improve and preserve health and well-being. Among the bestselling preparations are dietary supplement containing glucosamine and chondroitine sulfate taken to improve symptoms of osteoarthritis. METHODS AND RESULTS: We here present a case of a male patient with biopsy-proven acute and severe autoimmune hepatitis subsequent to intake of a preparation containing glucosamine and chondroitine sulfate. Response to steroids was favorable and resulted in complete remission of the patient. Diagnostic work-up of the case revealed no other possible cause of liver injury, and causality assessment using the Roussel Uclaf Causality Assessment Method (RUCAM) resulted in a possible causal relationship between intake of glucosamine and chondroitine sulfate and the adverse hepatic reaction. CONCLUSION: The present case recalls that products containing glucosamine and chondroitine sulfate can occasionally cause acute liver injury mimicking autoimmune hepatitis, and reminds of the potential dangers of compounds with poor efficacy and ill-defined safety records.