Papke David J, Viveiros Kathleen, Zota Victor, Gill Ryan M, González Iván A, Misdraji Joseph, Patil Deepa T
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Histopathology. 2025 Feb;86(3):410-422. doi: 10.1111/his.15333. Epub 2024 Oct 9.
Although turmeric is commonly ingested and well tolerated, there is increasing evidence that over-the-counter turmeric supplements can cause drug-induced liver injury. We sought to thoroughly characterise clinicopathological features of patients for whom liver injury was attributed clinically to turmeric supplements.
We identified 11 patients via retrospective pathology archive review: 10 females (91%) and one male, with a median age of 58 years (range = 37-66 years). Six patients (55%) were asymptomatic with abnormal liver function tests, while five patients (45%) presented with malaise and/or jaundice. Ten patients (91%) showed predominant transaminase abnormalities, while one exhibited predominant alkaline phosphatase elevation. Histologically, biopsies showed acute hepatitis (eight cases, 73%, including five pan-lobular and three zone 3-predominant inflammation), scattered lobular aggregates of histiocytes (two; 18%) and a chronic hepatitis pattern of injury (one; 9%). Mild bile duct injury was present in five biopsies (45%). All patients stopped ingesting turmeric supplements after presenting with liver injury, and four patients additionally received steroid therapy; liver function tests normalised in all patients. Roussel Uclaf causality assessment method (RUCAM) analysis estimated the likelihood of turmeric supplement-associated liver injury to be probable (eight cases) and possible (three).
Histological features in the 'possible' cases were consistent with drug-induced injury, highlighting the added benefit of histological analysis relative to RUCAM analysis isolation. This study underscores the need to obtain a full history of over-the-counter medications and supplements when investigating aetiologies for liver injury, including supplements purportedly containing innocuous compounds such as turmeric.
尽管姜黄通常可被摄入且耐受性良好，但越来越多的证据表明非处方姜黄补充剂可导致药物性肝损伤。我们试图全面描述临床上肝损伤归因于姜黄补充剂的患者的临床病理特征。
通过回顾病理档案，我们确定了11例患者：10名女性（91%）和1名男性，中位年龄为58岁（范围=37 - 66岁）。6例患者（55%）肝功能检查异常但无症状，而5例患者（45%）出现不适和/或黄疸。10例患者（91%）主要表现为转氨酶异常，1例主要表现为碱性磷酸酶升高。组织学上，活检显示急性肝炎（8例，73%，包括5例全小叶性和3例以3区为主的炎症）、散在的组织细胞小叶聚集（2例；18%）和慢性肝炎损伤模式（1例；9%）。5例活检（45%）存在轻度胆管损伤。所有患者在出现肝损伤后停止摄入姜黄补充剂，4例患者还接受了类固醇治疗；所有患者的肝功能检查均恢复正常。采用乌氏因果关系评估法（RUCAM）分析估计姜黄补充剂相关肝损伤的可能性为“很可能”（8例）和 “可能”（3例）。
“可能”病例的组织学特征与药物性损伤一致，突出了组织学分析相对于单独的RUCAM分析的额外益处。本研究强调，在调查肝损伤病因时，包括据称含有姜黄等无害化合物的补充剂，需要全面了解非处方药物和补充剂的使用史。
