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Reishi mushroom side effects liver8/1/2023 Aside from this, he has no past medical and surgical issues and has not travelled outside the country lately. He reported no fever, diarrhoea, abdominal pain or swelling, neuropsychiatric and B symptoms. There was also a 6-month history of intentional weight loss of 20 kg before the current presentation. Our patient is a 19-year-old man who presented with complaints of painless jaundice, tea-coloured urine, pale stools, worsening pruritus, appetite loss, and vomiting for 1 week. We present the following case in accordance with the CARE reporting checklist (available at ). To the best of our knowledge, this is the first recorded hepatotoxicity event caused by Ganoderma lucidum extract in a beverage. The substance was premixed into coffee powder as an active ingredient and sold in a box of 20 sachets. We recently encountered a patient presenting with cholestatic liver injury following prolonged Ganoderma lucidum ingestion, purportedly as an energy booster in his desire to lose weight. Although some herbal products may be safe when consumed sparingly, others may not be as forgiving ( 8, 9). Of note, the public is generally more receptive to complementary and alternative medicines, believing that the treatment used is natural and, thus, potentially safe compared to licensed medications ( 7). This data is projected to rise even further as traditional remedies become more widely available in various formulations or as additives in food and beverages. Over the last decade, we have also witnessed the rise of herbal consumption, resulting in an upsurge trend of herb-induced liver injury (HILI) incidence from 7% in 2004–2005 to 20% in 2013–2014 ( 5, 6). Recent data reports an annual incidence of DILI between 15–20 per 100,000 in the general population, although the numbers could be more significant owing to gross under-reporting from a lack of awareness and improper record keeping ( 2- 4). Received: 29 July 2022 Accepted: 01 September 2022 Published: 30 September 2022.ĭrug-induced liver injury (DILI) poses an exceptionally challenging diagnostic situation for physicians because of an expansive array of prescription drugs ( 1). Keywords: Ganoderma lucidum Lingzhi extract updated Roussel Uclaf Causality Assessment Method (updated RUCAM) herb-induced liver injury (HILI) case report In the absence of a specific biomarker, careful enquiry of exposure to various drugs and herbal products, preferably with a RUCAM checklist, is pertinent to avoid negligence. As demonstrated, such misperception can lead to a highly frustrating diagnostic conundrum resulting in expensive and unwarranted investigations with extended admission for procedures. In this scenario, Ganoderma lucidum is reputable for its hepatoprotective effect, though there is no conclusive scientific evidence in humans. Given that there were no concomitant hepatotoxins and progressive improvements following cessation of the offending agent, we attributed his cause of hepatotoxicity to HILI from prolonged Lingzhi ingestion.Ĭonclusions: Our case highlights a fundamental yet common pitfall encountered while managing HILI: patients may involuntarily withhold information based on their cultural beliefs and perception of what may or may not constitute a hepatotoxin. Further exploration following recovery revealed a year’s ingestion of premixed coffee with Ganoderma lucidum ( Lingzhi) extract as an energy booster to help with weight loss. Liver biopsy demonstrated marked hepatocanalicular cholestasis with an updated Roussel Uclaf Causality Assessment Method (RUCAM) score of 8, thus establishing a probable cause for HILI. Extensive second-line biochemical and radiological workup was normal. Clinical examination was unremarkable, while notable blood investigations revealed findings supportive of cholestatic liver injury. There was a significant, intentional weight loss of 20 kg 6 months before his presentation. In addition, clinicians must also be aware of the recent increase in the consumption of traditional medicine that can lead to herb-induced liver injury (HILI) and portends the risk of acute liver failure.Ĭase Description: We recently encountered a 19-year-old man who presented with painless jaundice, tea-coloured urine and pale stools for 1 week.
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