Aloe vera-induced acute toxic hepatitis in a healthy young man

The popularity and use of herbal medicine products are gradually increasing among healthy individuals. Yet, hepatic toxicity is a potential complication of these compounds that may lead to hepatic insufficiency[1]. Clinicians are likely to encounter cases of herbal remedy-related acute or chronic hepatitis at any time, even in healthy individuals. Here, wereport a case of aloe vera-induced acute hepatitis.A 24-year-old previously healthy man was hospitalized with complaints of jaundice, pruritus, fatigue, and right upper abdominal discomfort, together with mild nausea and vomit-ing. He had no previous history of liver disease, blood transfusion, or alcohol consumption. He had been taking aloe vera capsules containing 500 mg of the extractAloebarbadensismiller (1 capsule/day) for 3 weeks before presentation because he thought it would contribute to“healthier living”. He did not take any other medication concurrently with aloe vera. On admission, the patient's physical examination was normal, except for icteric pigmentation of the sclera and skin. Laboratory studies revealed total bilirubin9 mg/dl (normal v1.0 mg/dL), conjugated bilirubin 8.2 mg/dL(normalb0.2 mg/dL), aspartate aminotransferase 2550 U/L(normal 40 U/L), alanine aminotransferase 2400 U/L(normal 40 U/L), alkaline phosphatase 400 U/L (normal 155 U/L), gamma glutamyl transpeptidase 140 U/L (normal 49 U/L), and prothrombin activity 72% (INR 1.3). Full Blood count, serum electrolytes, glucose, creatinine, total protein, and immunoglobulin G, A, and M levels were within normal ranges. Serologic examinations for acute viral hepatitis(A, B, C, delta, E, cytomegalovirus, parvovirus, Epstein-Barr Virus, herpes virus, and human immunodeficiency virus) were all negative. Autoimmune hepatitis, Wilson's disease, andBudd-Chiari syndrome were ruled out by appropriate immunological and imaging methods. Abdominal ultrasound was also normal. A liver biopsy revealed marked portal and acinar infiltrates predominantly consisting of lymphocytes,monocytes, and eosinophils along with bridging necrosis,which were consistent with drug-induced hepatitis