PMID- 36252717
OWN - NLM
STAT- MEDLINE
DCOM- 20230131
LR  - 20240202
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Print)
IS  - 0002-9343 (Linking)
VI  - 136
IP  - 2
DP  - 2023 Feb
TI  - Liver Injury Associated with Turmeric-A Growing Problem: Ten Cases from the 
      Drug-Induced Liver Injury Network [DILIN].
PG  - 200-206
LID - S0002-9343(22)00740-9 [pii]
LID - 10.1016/j.amjmed.2022.09.026 [doi]
AB  - 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 cases enrolled the in US Drug-Induced Liver Injury Network (DILIN). 
      METHODS: All adjudicated cases enrolled in DILIN between 2004 and 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 6 since 2017. Of the 10 cases, 8 were 
      women, 9 were White, and median age was 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-hepatic 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 with 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.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Halegoua-DeMarzio, Dina
AU  - Halegoua-DeMarzio D
AD  - Thomas Jefferson University Hospital, Sidney Kimmel Medical College, 
      Philadelphia, Pa. Electronic address: dlh004@jefferson.edu.
FAU - Navarro, Victor
AU  - Navarro V
AD  - Albert Einstein Medical Center, Philadelphia, Pa.
FAU - Ahmad, Jawad
AU  - Ahmad J
AD  - Icahn School of Medicine at Mount Sinai, New York, NY.
FAU - Avula, Bharathi
AU  - Avula B
AD  - University of Mississippi, University Park.
FAU - Barnhart, Huiman
AU  - Barnhart H
AD  - Duke Clinical Research Institute, Durham, NC.
FAU - Barritt, A Sidney
AU  - Barritt AS
AD  - University of North Carolina, Chapel Hill.
FAU - Bonkovsky, Herbert L
AU  - Bonkovsky HL
AD  - Wake Forest University School of Medicine, Winston-Salem, NC.
FAU - Fontana, Robert J
AU  - Fontana RJ
AD  - University of Michigan Medical School, Ann Arbor.
FAU - Ghabril, Marwan S
AU  - Ghabril MS
AD  - Indiana University School of Medicine, Indianapolis.
FAU - Hoofnagle, Jay H
AU  - Hoofnagle JH
AD  - National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.
FAU - Khan, Ikhlas A
AU  - Khan IA
AD  - University of Mississippi, University Park.
FAU - Kleiner, David E
AU  - Kleiner DE
AD  - National Cancer Institute, National Institutes of Health, Bethesda, Md.
FAU - Phillips, Elizabeth
AU  - Phillips E
AD  - Vanderbilt University Medical Center, Nashville, Tenn.
FAU - Stolz, Andrew
AU  - Stolz A
AD  - University of Southern California Keck School of Medicine, Los Angeles, Calif.
FAU - Vuppalanchi, Raj
AU  - Vuppalanchi R
AD  - Indiana University School of Medicine, Indianapolis.
LA  - eng
GR  - U01 DK065211/DK/NIDDK NIH HHS/United States
GR  - U24 DK065176/DK/NIDDK NIH HHS/United States
GR  - U01 DK083027/DK/NIDDK NIH HHS/United States
GR  - U01 DK083020/DK/NIDDK NIH HHS/United States
GR  - U01 DK065238/DK/NIDDK NIH HHS/United States
GR  - U01 DK065193/DK/NIDDK NIH HHS/United States
GR  - U01 DK065176/DK/NIDDK NIH HHS/United States
GR  - U01 DK083023/DK/NIDDK NIH HHS/United States
GR  - U01 DK065184/DK/NIDDK NIH HHS/United States
GR  - U01 DK082992/DK/NIDDK NIH HHS/United States
GR  - U01 DK065201/DK/NIDDK NIH HHS/United States
GR  - U01 DK100928/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20221014
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 263T0E9RR9 (Dyphylline)
SB  - IM
CIN - Am J Med. 2023 Aug;136(8):e167. PMID: 37481332
MH  - Humans
MH  - Female
MH  - United States
MH  - Adult
MH  - Middle Aged
MH  - Aged
MH  - Male
MH  - Curcuma/adverse effects
MH  - Dyphylline
MH  - *Chemical and Drug Induced Liver Injury/etiology
MH  - *Hepatitis
PMC - PMC9892270
MID - NIHMS1845795
OTO - NOTNLM
OT  - Drug-induced liver injury
OT  - Hepatotoxicity
OT  - Herbal-induced liver injury
OT  - Turmeric
COIS- Declaration of Competing Interest NONE
EDAT- 2022/10/18 06:00
MHDA- 2023/02/01 06:00
PMCR- 2024/02/01
CRDT- 2022/10/17 19:24
PHST- 2022/09/24 00:00 [received]
PHST- 2022/09/28 00:00 [revised]
PHST- 2022/09/30 00:00 [accepted]
PHST- 2022/10/18 06:00 [pubmed]
PHST- 2023/02/01 06:00 [medline]
PHST- 2022/10/17 19:24 [entrez]
PHST- 2024/02/01 00:00 [pmc-release]
AID - S0002-9343(22)00740-9 [pii]
AID - 10.1016/j.amjmed.2022.09.026 [doi]
PST - ppublish
SO  - Am J Med. 2023 Feb;136(2):200-206. doi: 10.1016/j.amjmed.2022.09.026. Epub 2022 
      Oct 14.