Acute Toxic Hepatitis Caused by an Aloe Vera Preparation in a Young Patient: A Case Report with a Literature Review

Jeonghun Lee; Mi Sun Lee; Kwan Woo Nam

doi:10.4166/kjg.2014.64.1.54

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Lee, Lee, and Nam: Acute Toxic Hepatitis Caused by an Aloe Vera Preparation in a Young Patient: A Case Report with a Literature Review

Case Report

Korean J Gastroenterol 2014;64(1):54-58.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.1.54

Acute Toxic Hepatitis Caused by an Aloe Vera Preparation in a Young Patient: A Case Report with a Literature Review

Jeonghun Lee, Mi Sun Lee¹, Kwan Woo Nam

Department of Internal Medicine, Daejeon Sun Hospital, Daejeon, Korea

¹Department of Pathology, Daejeon Sun Hospital, Daejeon, Korea

Correspondence to: Kwan Woo Nam, Department of Internal Medicine, Daejeon Sun Hospital, 29 Mokjung-ro, Jung-gu, Daejeon 301-725, Korea. Tel: +82-42-220-8575, Fax: +82-42-252-5505, E-mail: namganwoo@naver.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aloe is one of the leading products used in phytomedicine. Several cases of aloe-induced toxic hepatitis have been reported in recent years. However, its toxicology has not yet been systematically described in the literature. A 21-year-old female patient was admitted to our hospital with acute hepatitis after taking an aloe vera preparation for four weeks. Her history, clinical manifestation, laboratory findings, and histological findings all led to the diagnosis of aloe vera-induced toxic hepatitis. We report herein on a case of acute toxic hepatitis induced by aloe vera.

Keywords: Hepatitis, Aloe, Health food

References

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Fig. 1.

The container bottle and gel of the aloe vera preparation that the patient had taken.

Fig. 2.

(A) Microphotograph of a gun biopsy specimen of the liver (H&E, ×200). (B) Higher magnification showed mixed infiltration of inflammatory cells at the portal and lobular spaces with neutrophils, lymphocytes, and eosinophils (H&E, ×400).

Fig. 3.

(A) Upon discontinuation of the intake of aloe vera, the liver enzymes returned to their normal level. (B) Upon discontinuation of the intake of aloe vera, the white blood cell and platelet counts returned to their normal levels. TB, total bilirubin; WBC, white blood cell.

Table 1.

Patient Characteristics of Previously Reported Aloe-induced Toxic Hepatitis

Patient (No)	Sex	Age (yr)	Medication duration (wk)	ALT (IU/L)	ALP (IU/L)	TB (mg/dL)	Type of liver injury	Re-challenge	Causality assessment ^a
1⁷	F	57	4	1,480	256	8.90	Hepatocellular	ND	Probable
2⁸	F	57	24	565	309	1.07	Hepatocellular	ND	Probable
3⁸	F	62	12	1,564	211	14.64	Hepatocellular	Positive	Definite
4⁸	F	55	20	641	291	0.48	Hepatocellular	ND	Probable
5⁹	F	73	260	1,451	535	10.70	Hepatocellular	ND	Probable
6¹⁰	M	26	156	799	200	8	Hepatocellular	ND	Probable
7¹¹	M	24	3	2,550	400	9.00	Hepatocellular	ND	Probable
Current case	F	21	4	1,703	709	1.5	Hepatocellular	ND	Definite

^a The causality assessment according to the Roussel Uclaf Causality Assessment Method (RUCAM)/Council for International Organizations of Medical Sciences (CIMOS) criteria.

F, female; M, male; TB, total bilirubin; ND, not done.

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