Weinstein DH, Twaddell WS, Raufman JP, Philosophe B, Mindikoglu AL. SlimQuick™ - associated hepatotoxicity in a woman with alpha-1 antitrypsin heterozygosity. World J Hepatol 2012; 4(4): 154-157 [PMID: 22567188 DOI: 10.4254/wjh.v4.i4.154]
Corresponding Author of This Article
Ayse L Mindikoglu, MD, MPH, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 S. Greene Street, N3W50, Baltimore, MD 21201, United States. amindiko@medicine.umaryland.edu
Article-Type of This Article
Case Report
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World J Hepatol. Apr 27, 2012; 4(4): 154-157 Published online Apr 27, 2012. doi: 10.4254/wjh.v4.i4.154
SlimQuick™ - associated hepatotoxicity in a woman with alpha-1 antitrypsin heterozygosity
Douglas H Weinstein, William S Twaddell, Jean-Pierre Raufman, Benjamin Philosophe, Ayse L Mindikoglu
Douglas H Weinstein, Jean-Pierre Raufman, Ayse L Mindikoglu, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States
William S Twaddell, Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Benjamin Philosophe, Division of Transplantation Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Author contributions: Weinstein DH and Mindikoglu AL contributed to design, acquisition of data, interpretation of data, writing and revising the manuscript; Twaddell WS and Philosophe B contributed to acquisition of data, interpretation of data and revising the manuscript; Raufman JP contributed to revising and editing the manuscript; all authors approved the final version of the manuscript to be published.
Supported by in part by Grant Number 1 K23 DK089008-01 from the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases to Ayse L Mindikoglu, MD, MPH and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the NIH
Correspondence to: Ayse L Mindikoglu, MD, MPH, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 S. Greene Street, N3W50, Baltimore, MD 21201, United States. amindiko@medicine.umaryland.edu
Telephone: +1-410-3281358 Fax: +1-410-3281897
Received: February 19, 2011 Revised: September 1, 2011 Accepted: February 24, 2012 Published online: April 27, 2012
Abstract
Green tea (Camellia sinensis)-associated hepatotoxicity is reported. However, the presence of alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated drug-induced liver injury (DILI) is unknown. A previously healthy woman with alpha-1 antitrypsin MZ phenotype who took SlimQuick™, an herbal supplement containing green tea extract, developed severe hepatotoxicity requiring corticosteroid treatment. Green tea-associated hepatotoxicity is reviewed and alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated DILI is discussed. Liver biopsy demonstrated marked inflammation with necrosis suggestive of toxic injury with diffuse alpha-1 antitrypsin globule deposition on immunostaining. Corticosteroid therapy resulted in rapid clinical improvement. Alpha-1 antitrypsin MZ phenotype may increase vulnerability to herbal hepatotoxicity.
