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Keerthana Kesavarapu [1] and Mitchell Kang [1] and Jaewook James Shin [2] and Kenneth Rothstein [3; 4]

Academic Editor: Hideto Kawaratani

1, Department of Internal Medicine, Drexel University Hospital, Philadelphia, PA, USA

2, Drexel School of Medicine, Philadelphia, PA, USA

3, Department of Gastroenterology, Drexel University Hospital, Philadelphia, PA, USA

4, Department of Hepatology, Drexel University Hospital, Philadelphia, PA, USA

Received Apr 15, 2017; Revised Aug 4, 2017; Accepted Aug 13, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

The American Association for the Study of Liver Diseases (AASLD) defines acute fulminant liver failure as an acute deterioration of function resulting in altered mentation and coagulopathy without any known preexisting disease [1]. In 308 patients from 17 tertiary care centers participating in US Acute Liver Failure Study Group, drug reactions including acetaminophen overdose were the presumptive cause in 52% of cases [2]. Prevalent medication offenders include acetaminophen, mushrooms, and antiepileptics (phenytoin and valproic acid); however herbal supplement induced hepatotoxicity is gaining prevalence. According to the Drug-Induced Liver Injury Network (DILIN), causes of acute liver failure (ALF) from herbal supplements have increased from 7% to 20% over their study period from 2007 to 2013 [3]. This number is probably a gross underestimation as patients do not report use to their physicians and physicians do not report side effects to the Food and Drug Association (FDA) and might not be identified by DILIN. Here we report a case of ALF after the use of an herbal detoxification tea marketed to be hepatoprotective.

2. Case Report

A 60-year-old female with past medical history of hypertension presented with new-onset generalized weakness and lethargy worsening over the past two weeks. She denied any fevers, chills, changes in stool, changes in mental status, sick contacts, or recent travel. Her past medical history was significantly only for obesity. Her social history included no tobacco use, frequent alcohol consumption (3 glasses of wine every night), no IV drug use, no acetaminophen use, and no high risk sexual activity. Her alcohol use has been stable since she started drinking ten years ago. Previous laboratory testing showed normal liver function....

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