Acute hepatitis associated with the use of Ma-huang in a young adult

The use of herbal remedies continues to increase in developed countries. Ma-huang is a Chinese herbal product that is often used for weight loss and energy improvement. One of the adverse effects of Ma-huang is hepatotoxicity. We present the case of an adult with acute hepatitis due to Ma-huang. A previously healthy 28-year-old man was admitted to our department complaining of epigastric pain and nausea. He was jaundiced. He reported no recent unusual travel, exposure to hepatitis, or alcohol or drug abuse. Further inquiry revealed the use of Ma-huang for bodybuilding during the previous 2 months. The patient stopped taking Ma-huang on the day of his admission. Liver biochemistry on admission was indicative of hepatitis, while serology for hepatitis B, C, herpes viruses, and HIV were negative. Antinuclear antibodies were present at a titer of 1:80 and anti-smooth muscle antibodies were negative. Abdominal ultrasound and computed tomography were normal. Nine days later, the patient's liver biochemistry was normal, antinuclear antibodies were negative, and his clinical condition had improved. The active component in Ma-huang is ephedrine. Dilated cardiomyopathy, arrhythmias, headache, insomnia, and nervousness are some of Ma-huang's known adverse effects. Hepatotoxicity resulting from the use of Ma-huang is quite rare, with only a few cases of acute hepatitis having been reported [1]. Without specific clinicopathological findings, the diagnosis of hepatitis is based on the temporal sequence of clinical events associated with its use and on the exclusion of other causes of hepatitis. The mechanism for liver injury seems to be either immune-mediated or idiosyncratic. The purpose of our report is to indicate that physicians should always consider herbal medicines as a possible cause of unexplained hepatitis. Given that its distribution remains unsupervised, patients should be asked specifically about their use. The immediate cessation of Ma-huang when hepatitis is diagnosed is mandatory; otherwise, irreversible liver injury may occur [2]. References