[Fulminant liver failure after administration of the herbal antidepressant Kava-Kava].
METHODS
A 60 year-old woman was admitted to hospital because of jaundice, fatigue, weight loss over several months and icteric skin. Because of progressive liver failure, concomitant renal failure and progressive encephalopathy she was transferred to an intensive care unit.


METHODS
Biochemical tests revealed acute liver failure with high levels of total and conjugated bilirubin (30 mg/dl) as well as aspartate aminotransferase (921 IU/l) and alanine aminotransferase (1350 IU/l) concentrations. Prothrombin time was less than 10 %. Serological tests could rule out viral hepatitis, metabolic or autoimmune causes of liver failure. On abdominal computed tomography and ultrasonography no pathological changes were detected. Above all portal vein thrombosis, ascites, focal lesions of the liver and extrahepatic cholestasis could be excluded. Liver histology showed extensive hepatocellular necrosis with intrahepatic cholestasis.


METHODS
The patient's physical condition deteriorated. She had to be intubated because of respiratory insufficiency and encephalopathy stage IV. Because of progressive liver failure under conservative treatment the patient received an orthotopic liver transplant 11 days after admission.


CONCLUSIONS
The exclusion of other causes and the histological diagnosis made Kava-Kava as the cause of acute liver failure most likely. This is the 18th case of Kava-Kava induced liver failure reported to the European regulatory authorities.
Kraft
M
M
Medizinische Klinik und Poliklinik B, Universität Münster, Germany.
Spahn
T W
TW
Menzel
J
J
Senninger
N
N
Dietl
K H
KH
Herbst
H
H
Domschke
W
W
Lerch
M M
MM
D000410:Alanine Transaminase / Q000097:blood; D000928:Antidepressive Agents; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D020901:Kava / Q000009:adverse effects* / Q000627:therapeutic use; D008099:Liver / Q000473:pathology*; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008875:Middle Aged; D008517:Phytotherapy; D010946:Plants, Medicinal; D011169:Portal Vein / Q000473:pathology; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology
D000928:Antidepressive Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin