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Cited by 119

The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.

Liver Injury Associated with Turmeric—A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network [DILIN]

Halegoua-DeMarzio, Dina, Navarro, Victor, Ahmad, Jawad, Avula, Bharathi, Barnhart, Huiman, Barritt, A. Sidney, Bonkovsky, Herbert L., Fontana, Robert J., Ghabril, Marwan S., Hoofnagle, Jay H., Khan, Ikhlas A., Kleiner, David E., Phillips, Elizabeth, Stolz, Andrew, Vuppalanchi, Raj·2023·The American Journal of Medicine
DOI 10.1016/j.amjmed.2022.09.026PMC PMC9892270
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Abstract

Background: Turmeric is a commonly used herbal product that has been implicated in causing liver injury. The aim of this case series is to describe the clinical, histologic and human leukocyte antigen (HLA) associations of turmeric-associated liver injury enrolled the U.S. Drug Induced Liver Injury Network (DILIN). Methods: All adjudicated cases enrolled in DILIN between 2004–2022 in which turmeric was an implicated product were reviewed. Causality was assessed using a 5-point expert opinion score. Available products were analyzed for the presence of turmeric using ultra-high-performance liquid chromatography. Genetic analyses included HLA sequencing. Results: Ten cases of turmeric-associated liver injury were found, all enrolled since 2011 and six since 2017. Of the 10 cases, 8 were women, 9 White and median age 56 years (range, 35–71). Liver injury was hepatocellular in 9 patients and mixed in 1. Liver biopsies in 4 patients showed acute hepatitis or mixed cholestatic-hepatitic injury with eosinophils. Five patients were hospitalized, and 1 patient died of acute liver failure. Chemical analysis confirmed the presence of turmeric in all 7 products tested; 3 also contained piperine (black pepper). HLA typing demonstrated that 7 patients carried HLA-B*35:01, 2 of whom were homozygous, yielding an allele frequency of 0.450 compared to population controls of 0.056–0.069. Conclusion: Liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.

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Metadata

Authors
Halegoua-DeMarzio, D., Navarro, V., Ahmad, J., Avula, B., Barnhart, H., Barritt, A. S., Bonkovsky, H. L., Fontana, R. J., Ghabril, M. S., Hoofnagle, J. H., Khan, I. A., Kleiner, D. E., Phillips, E., Stolz, A., & Vuppalanchi, R.
ORCID
Halegoua-DeMarzio, Dina
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2023-02
Volume
136
Issue
2
Pages
200-206
ISSN
0002-9343
DOI
10.1016/j.amjmed.2022.09.026
PMC
PMC9892270
Cited by
119
References
22
Language
en
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