Hepatitis secondary to consumption of piñalim

Introduction and Objectives

The use of natural products without proper assessment is common and favored by the popularity of phytotherapeutics. The regulations related to the prescription and use of these products are scarce, which leads to their being widely used in self-medication. We present the clinical case of a woman who consumed piñalim and presented hepatotoxicity

Materials and Patients

A 29-year-old woman without significant history. She was admitted to the general surgery service for cholecystectomy. After preoperative evaluation, abnormalities in liver function tests (LFT) stood out, for which reason they intentionally asked about the consumption of alcohol, drugs, supplements or herbal and/or homeopathic products, referring to the daily consumption during the last year of PIÑALIM (red, green and white tea) in order to lose weight. Ultrasound of the liver and bile ducts reported: liver of normal shape, size and situation, with no evidence of solid or cystic lesions. Bile duct without dilatation. Gallbladder with a 5.6mm thick wall, without images suggestive of stones. The surgical report showed a lack of findings in the gallbladder and liver. The jaundice and altered LFT persisted in the postoperative period (mixed pattern); additional tests were performed: HBV-HCV-HAV-HIV viral panel: TORCH negative. Negative Tomography of the abdomen without relevant findings. ANA: Negative Until now, the only hepatotoxic agent identified (PIÑALIM) had already been suspended, so this behavior was maintained, avoiding the consumption of any drug. In the following control, the LFT maintained a downward trend, until normalizing 6 months after the definitive suspension of the infusion. (Table 1)

Results

After the definitive suspension of the tea, the LFT were normalized, thus concluding the direct relationship of the product by having a score on the CIOM/RUCAM scale of 9 (definitive cause of hepatotoxicity).

Conclusions

The report of hepatitis associated with infusions is becoming more frequent, it is important to raise awareness about our patients in the "non-safety" of natural products and in the medical team to alert about these products and avoid procedures unnecessary surgeries.

Ethical statement

The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Table 1 Liver Function Tests

Preoperative	Postoperative	6 months of suspension of the hepatotoxic
TB:11.1mg/dl, DB:8.1mg/dl, IB:3.0mg/dl, TSA: 159U/L, TLA: 356U/L, AF: 281U/L, HDL: 545U/L, TGG:459U/L	TB: 8.0mg/dl, DB: 6.3mg/dl, IB: 1.7mg/dl, TSA: 111U/L, TLA: 242U/L, AF: 180U/L, HDL: 400U/L y TGG: 298U/L	TB: 1.3mg/dl, DB: 0.7mg/dl, IB: 0.6mg/dl, TSA: 36U/L, TLA: 44U/L, AF: 120U/L, HDL: 250U/L y TGG: 66U/L