Grifola frondosa Extract Induced Acute Hepatic Injury.
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Date
2014-03-01
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Abstract
Aim: To describe a case of acute hepatic injury related to the use of Grifola frondosa in a
patient with colon cancer.
Case Presentation: Patient is a 67 year old female with stage IV poorly differentiated
adenocarcinoma of the colon, who presented with epigastric pain one month after
resection of her primary tumor. A staging PET scan revealed metastasis to regional
lymph nodes without solid organ involvement. Her home medications include
longstanding amlodipine and losartan, and a recently started Grifola frondosa derivative.
Her laboratory data was significant only for acute transaminitis (AST:967 U/L, ALT:768
U/L) without hyperbilirubinemia. Alcohol, acetaminophen, and a viral panel (EBV, CMV,
hepatitis A/B/C) were all negative. A CT scan revealed heterogenous liver parenchyma
without focal lesions. A subsequent liver biopsy demonstrated active portal inflammation
with eosinophilic infiltration.
Discussion: The etiologies of significant acute transaminitis include viral hepatitis,
ischemic liver injury, acetaminophen toxicity and drug-induced liver injury (DILI). Viral
and ischemic hepatitis and acetaminophen toxicity were excluded based on laboratory analysis and imaging studies. Liver biopsy findings demonstrating the characteristic
eosinophilic infiltration of a drug reaction favored DILI as the etiology of transaminitis in
this case. With a RUCAM score of 7 calculated based on history, clinical course, and
objective data, DILI was concluded to be probably attributed to the patient’s recent use of
the Grifola frondosa extract.
Conclusion: A diagnosis of drug induced liver injury probably secondary to the use of
Grifola frondosa extract was made after excluding all other causes of significant acute
transaminitis.
Description
Keywords
Grifola frondosa, Maitake mushroom, acute hepatic injury, drug induced liver injury
Citation
Sridevi Ramalingam, Trupti Patel, Alejandro Calvo. Grifola frondosa Extract Induced Acute Hepatic Injury. British Journal of Medicine and Medical Research. 2014 Mar; 4(7): 1567-1576.