Medical Mystery: What's destroying her liver?
A patient came to Thomas Jefferson University Hospital's emergency department after a week of nausea, vomiting, progressive yellowing of her eyes, and abdominal pain. When her symptoms began, she thought she was just coming down with the flu.
A patient came to Thomas Jefferson University Hospital's emergency department after a week of nausea, vomiting, progressive yellowing of her eyes, and abdominal pain. When her symptoms began, she thought she was just coming down with the flu. By the time she arrived at the hospital, the emergency team suspected liver failure.
I met the patient shortly after for a hepatology consultation. She was generally in good health and was on no prescribed medications. During the physical exam, I noted she was jaundiced and had mild swelling of her abdomen and legs. She told me that over the last few years, she had struggled with her weight, and in the three weeks before coming to the hospital, she had been taking a weight-loss supplement containing a green tea extract and had been following a low-calorie diet.
Initial lab work and imaging confirmed severe liver injury. But what was causing it? After two days, lab tests still did not reveal a cause of her acute liver failure, and her condition worsened. She was quickly evaluated and listed for a liver transplant. A donor liver was available days later, and she underwent a transplant.
When her liver was removed, the cause of her acute liver failure was revealed. It was an answer our team had suspected.
Solution
The liver biopsy revealed extensive necrosis (dead tissue) in a pattern that pointed to a drug- or toxin-related injury. The weight-loss supplement likely led to her quick deterioration.
Green tea extract is often used in weight-loss supplements because of its ability to speed metabolism. Though green tea has been shown to have some health benefits, and drinking green tea is perfectly safe, the pure extract in high doses can lead to liver damage in animals. A European herbal weight-loss product with green tea extract was withdrawn from Spanish and French markets in 2003 after being linked to 13 cases of hepatotoxicity, one of which required a liver transplant. Unfortunately, green tea extract remains in many products.
Unlike prescription medications, over-the-counter supplements are not regulated by the U.S. Food and Drug Administration. This month, the New England Journal of Medicine published research showing that each year, 23,000 emergency department visits in the U.S. can be attributed to dietary supplements.
Despite widespread use, many patients don't tell their doctors they are taking an herbal or weight-loss supplement.
Thankfully, my patient's health improved after her liver transplant, and she was able to return home with her family after her recovery.
I encourage patients to talk to a doctor before taking any dietary or herbal supplement.
Dina Halegoua-De Marzio, who is board-certified in internal medicine and gastroenterology, is an assistant professor at Sidney Kimmel Medical College at Thomas Jefferson University. She also directs Jefferson's Fatty Liver Center and is associate program director of the Transplant Hepatology Fellowship.
Read more from the Check Up blog »
