Liver injury induced by Phyllanthus niruri (chancapiedra), a natural remedy for urolithiasis
DOI:
https://doi.org/10.59093/27112330.103Keywords:
drug induced liver injury, herbal medicine, Phyllantus, hepatitis.Abstract
Both drug-induced liver injury (DILI) and herb-induced liver injury (HILI) are a growing concern in contemporary healthcare that poses significant clinical challenges due to their varied etiology, clinical presentations, and potential life-threatening outcomes. We present the case of a 38-year-old male patient with a history of kidney stones who consulted for low back pain and hematuria. On admission he presented with jaundice, hepatomegaly, pain on palpation in the right iliac fossa and no signs of chronic liver disease, with abnormal liver function tests, which showed a hepatocellular pattern associated with hyperbilirubinemia. Biliary obstruction, portal thrombosis, autoimmune and viral hepatitis were ruled out, with negative autoimmune panel. The patient reported consuming an herbal remedy for kidney stones called “stone-breaking wine (chancapiedra)”, presumed to contain Phyllanthus niruri, five days before the onset of symptoms. A liver biopsy revealedacute hepatitis with mixed inflammatory infiltrate. Due to worsening liver function tests and suspicion of idiosyncratic DILI, a therapeutic trial with corticosteroids was initiated, which resulted in clinical and liver profile improvement. The severity of this case reminds us of the need to increase follow-up by drug regulatory authorities, implement educational campaigns for patients, and inform the community about products with active alerts.
Downloads
References
Fontana RJ, Liou I, Reuben A, Suzuki A, Fiel MI, Lee W, et al. AASLD practice guidance on drug, herbal, and dietary supplement-Induced liver injury. Hepatology 2023;77:1036-1065. https://doi.org/10.1002/hep.32689.
Nunes DR, Monteiro CS, Dos Santos JL. Herb-induced liver injury-A challenging diagnosis. Healthcare 2022;10:278. https://doi.org/10.3390/healthcare10020278.
Cano-Paniagua A, Amariles P, Angulo N, Restrepo-Garay M. Epidemiology of drug-induced liver injury in a university hospital from colombia: updated RUCAM being used for prospective causality assessment. Ann Hepatol 2019;18:501-507. https://doi.org/10.1016/j.aohep.2018.11.008.
Bessone F, Hernandez N, Tagle M, Arrese M, Parana R, Méndez-Sánchez N, et al. Drug-induced liver injury: a management position paper from the Latin American Association for Study of the Liver. Ann Hepatol 2021;24:100321. https://doi.org/10.1016/j.aohep.2021.100321.
U. S. Department of Health and Human Services Food and Drug Administration, Center for Drug Evaluation and Research Center for Biologics Evaluation and Research. Guidance for industry drug-induced liver injury: premarketing clinical evaluation drug safety; 2009. Disponible en https://www.fda.gov/regulatory-information/search-fda-guidance-documents/drug-induced-liver-injury-premarketing-clinical-evaluation.
Maddrey W, Greenberger N, Blumberg R, Burakoff R. Chapter 49: Drug-induced liver disease in CURRENT diagnosis & treatment: gastroenterology, hepatology, & endoscopy. 3er ed. Nueva York: McGraw-Hill Education; 2016. Disponible en https://www.accessmedicine.mhmedical.com/content.aspx?aid=1119991073.
Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, et al. Features and outcomes of 899 patients with drug-induced liver injury: the DILIN prospective study. Gastroenterology 2015;148:1340-1352.e7. https://doi.org/10.1053/j.gastro.2015.03.006.
Andrade RJ, Lucena MI, Fernández MC, Pelaez G, Pachkoria K, García-Ruiz E, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the spanish registry over a 10-year period. Gastroenterology 2005;129:512-521. https://doi.org/10.1053/j.gastro.2005.05.006.
Shen T, Liu Y, Shang J, Xie Q, Li J, Yan M, et al. Incidence and etiology of drug-induced liver injury in Mainland China. Gastroenterology 2019;156:2230-2241.e11. https://doi.org/10.1053/j.gastro.2019.02.002.
Bessone F, García-Cortés M, Medina-Caliz I, Hernández N, Parana R, Mendizabal M, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI network. Clin Gastroenterol Hepatol 2022;20:e548-e563. https://doi.org/10.1016/j.cgh.2021.01.011.
Kodakandla V, Syamasundara B, Singha R, Husain A, Kiso Y, Hikino H. Antihepatotoxic principles of Phyllanthus niruri herbs. J Ethnopharmacol 1985;14(1):41-44. https://doi.org/10.1016/0378-8741(85)90026-1.
Kaur N, Kaur B, Sirhindi G. Phytochemistry and pharmacology of phyllanthus niruri L.: a review. Phytother Res 2017;31:980-1004. https://doi.org/10.1002/ptr.5825.
Lee NY, Khoo WK, Adnan MA, Mahalingam TP, Fernández AR, Jeevaratnam K. The pharmacological potential of Phyllanthus niruri. J Pharm Pharmacol 2016;68:953-969. https://doi.org/10.1111/jphp.12565.
Asare G, Addo P, Bugyei K, Gyan B, Adjei S, Otu-Nyarko LS, et al. Acute toxicity studies of aqueous leaf extract of Phyllanthus niruri. Interdiscip Toxicol 2011;4:206-210. https://doi.org/10.2478/v10102-011-0031-9.
Baiguera C, Boschetti A, Raffetti E, Zanini B, Puoti M, Donato F. Phyllanthus niruri versus placebo for chronic hepatitis B virus infection: a randomized controlled trial. Complement Med Res 2018;25:376-382. https://doi.org/10.1159/000484927.
Sowjanya K, Girish C, Bammigatti C, Chandrasekhar N, Lakshmi P. Efficacy of Phyllanthus niruri on improving liver functions in patients with alcoholic hepatitis: a double-blind randomized controlled trial. Indian J Pharmacol 2021;53:448-456. https://doi.org/10.4103%2Fijp.IJP_540_20.
Survandita D, Ephrem O. Phyllanthus niruri (stone breaker) herbal therapy for kidney stones; a systematic review and meta-analysis of clinical efficacy and google trends analysis of public interest. Can J Urol 2020;27:10162-10166.
Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA). Invima alerta sobre producto fraudulento comercializado como: “Chancapiedra rompe cálculos”. Disponible en http://app.invima.gov.co/alertas/ckfinder/userfiles/files/ALERTAS%20SANITARIAS/Alimentos_Bebidas/2017/Agosto/CHANCAPIEDRA%20ROMPE%20CALCULOS%20(1).pdf.
Lewis JH, Seeff LB. The origins of the modern‐day study of drug hepatotoxicity: focus on Hyman J. Zimmerman. Clin Liver Dis 2020;15:S25-S36. https://doi.org/10.1002/cld.856.
Andrade RJ, Aithal GP, Björnsson ES, Kaplowitz N, Kullak-Ublick GA, Larrey D, et al. EASL Clinical Practice Guidelines: drug-induced liver injury. J Hepatol 2019;70:1222-1261. https://doi.org/10.1016/j.jhep.2019.02.014.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 The authors retain all copyright and grant the Colombian Association of Hepatology a non-exclusive right to publish and disseminate their work.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Hepatología’s authorship policy is based on the criteria established by the International Committee of Medical Journal Editors (ICMJE) to credit a person for their work while assigning them responsibility for its publication.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
