2nd Department of Internal Medicine, Cluj County Clinical Emergency Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Surgery Department, and.
Am J Ther. 2024;31(4):e382-e387. doi: 10.1097/MJT.0000000000001708. Epub 2024 May 30.
In instances where individuals manifest elevated transaminase levels without a clearly discernible cause, a comprehensive patient history proves invaluable in unveiling latent triggers. In this report, we present 2 cases of herb-induced liver injury (HILI) characterized by severe hypertransaminasemia attributed to the consumption of Chelidonium majus L . (also known as greater celandine [GC]), an agent considered an alternative therapeutic remedy.
Exploring the occurrence and range of clinical manifestations in HILI linked to Chelidonium majus L ., while also investigating the potential triggers and predisposing factors for hepatotoxic reactions post Chelidonium majus L. usage, remains challenging due to the absence of definitive laboratory tests to identify the causative agent.
Two case reports were detailed, and a systematic literature review using PubMed was conducted including published literature till March 2023. Moreover, a manual search of reference lists of pertinent articles was performed to identify any additional relevant missed publications.
In the first case, a 64-year-old woman presented with jaundice, revealing a 1-month history of using GC capsules to manage gallstones. Diagnostic assessment identified HILI, gallstones, and choledocolithiasis, with transaminase levels exceeding 1000 IU/L. After discontinuing GC and receiving intravenous therapy with amino acids and phospholipids, the patient's condition significantly improved. Subsequently, she underwent endoscopic common bile duct stone removal and cholecystectomy. In the second case, a 66-year-old woman presented with elevated liver function test results discovered incidentally during musculoskeletal pain evaluation. Upon further questioning, the patient disclosed regular consumption of GC tea for "health promotion." Following intravenous therapy using amino acids and phospholipids, her transaminase levels returned to normal. The literature review identified 38 cases of HILI associated with GC preparations, primarily in adult women aged 27-77 years, with a predominant reporting location in Germany. Various forms of GC were used, with treatment durations ranging from 1 week to a year. Discontinuation of GC generally led to recovery in these cases.
Chelidonium majus L ., a potent herb often used in alternative medicine, has significant hepatotoxic potential, requiring physicians to be vigilant in cases of unexplained liver injury.
当个体出现转氨酶升高而无明显病因时，全面的患者病史对于揭示潜在的诱因至关重要。在本报告中，我们介绍了两例由Chelidonium majus L.（又称 greater celandine [GC]）引起的肝损伤（HILI），这些患者因使用这种被认为是替代治疗方法的药物而出现严重的高转氨酶血症。
探索与 Chelidonium majus L. 相关的 HILI 的发生和临床表现范围，同时研究使用 Chelidonium majus L. 后肝毒性反应的潜在诱因和易患因素，由于缺乏明确的实验室检测来确定致病因子，这仍然具有挑战性。
详细描述了两例病例报告，并使用 PubMed 进行了系统的文献回顾，包括截至 2023 年 3 月的已发表文献。此外，还对相关文章的参考文献列表进行了手动搜索，以确定任何其他遗漏的相关出版物。
在第一个病例中，一位 64 岁女性因黄疸就诊，她在 1 个月前开始使用 GC 胶囊治疗胆结石。诊断评估确定为 HILI、胆结石和胆总管结石，转氨酶水平超过 1000IU/L。停止使用 GC 并接受氨基酸和磷脂的静脉治疗后，患者病情显著改善。随后，她接受了内镜下胆总管结石取出术和胆囊切除术。在第二个病例中，一位 66 岁女性因肌肉骨骼疼痛评估时意外发现肝功能试验结果升高就诊。进一步询问时，患者透露她经常饮用 GC 茶以“促进健康”。在接受氨基酸和磷脂的静脉治疗后，她的转氨酶水平恢复正常。文献综述确定了 38 例与 GC 制剂相关的 HILI，主要发生在 27-77 岁的成年女性中，主要报告地点在德国。使用了各种形式的 GC，治疗持续时间从 1 周到 1 年不等。停用 GC 后，这些病例通常会恢复。
Chelidonium majus L.，一种常用于替代医学的强效草药，具有显著的肝毒性潜力，这要求医生在遇到不明原因的肝损伤时保持警惕。
