Hepatitis induced by Teucrium viscidum.
BACKGROUND
In Hong Kong, Chinese medicine is popular and coexists with orthodox Western medicine. Despite a long history of use, many herbs have not been submitted to rigorous scientific testing and there are reports of hepatotoxicity. We describe a woman who developed acute hepatitis after drinking an herbal remedy containing Teucrium viscidum.


METHODS
A previously healthy 51-year-old woman was admitted to a regional hospital because of jaundice, with complaints of nausea, vomiting, and tea-colored urine for three days prior to admission. She denied any recent ingestion of known hepatotoxins, but she had consumed an herbal remedy for low back pain for three days before the onset of symptoms. She was icteric and had a serum total bilirubin level of 11.4 mg/dL, alanine aminotransferase of 2620 U/L, aspartate aminotransferase of 1876 U/L, and alkaline phosphatase level of 186 U/L. Discontinuation of the herbal remedy resulted in normalization of the liver enzymes two months later.


CONCLUSIONS
This is the first report of hepatitis probably related to use of Teucrium viscidum. The herb is infrequently used in Chinese medicine for treatment of rheumatic and bleeding disorders. T. viscidum contains teucvin, similar to other Teucrium species and is related to T. chamaedrys, commonly known as germander, which is a well documented cause of hepatotoxicity.


CONCLUSIONS
Our findings suggest that Teucrium viscidum can cause hepatotoxicity similar to that of germander.
Poon
Wing Tat
WT
Toxicology Reference Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong, Hong Kong. poonwt@ha.org.h
Chau
Tai Lin
TL
Lai
Chi Kong
CK
Tse
Ka Yan
KY
Chan
Yiu Cheung
YC
Leung
King Sun
KS
Chan
Yan Wo
YW
D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001628:Beverages / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology*; D008111:Liver Function Tests; D017116:Low Back Pain / Q000188:drug therapy; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D010946:Plants, Medicinal / Q000009:adverse effects; D031367:Teucrium / Q000009:adverse effects*
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin