title: Toxic hepatitis due to a food supplement: "Natural" is no synonym for "harmless".
abstract: OBJECTIVE
  Herbal products are increasingly used in modern medicine for numerous indications. They are not considered as drugs and thus often not linked to side effects.
  
  
  METHODS
  A 77-year-old patient presented with silent icterus and biochemical evidence of hepatocellular damage. Because of dyslipidaemia, he was recently prescribed Controchol(®), a food supplement containing red yeast and green tea extracts.
  
  
  RESULTS
  Liver biopsy showed necro-inflammatory destruction of liver parenchym, collapse of reticulin matrix, cholestasis and gall duct damage, compatible with toxic hepatitis. After discontinuation of Controchol(®), there was a gradual normalisation of the liver function tests. Liver injury is a known side effect of both red yeast and green tea extracts. After exclusion of other causes, we therefore concluded our patient had suffered from Controchol(®)-induced toxic hepatitis.
  
  
  CONCLUSIONS
  Products that are conceived as "natural" alternatives for pharmacological drugs, like food supplements, are not free of side effects per se, and should not be considered as "harmless".
authors.affiliation: Department of Gastroenterology and Hepatology, Sint-Vincentius Hospital, Sint-Vincentiusstraat 20, 2018 Antwerpen, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
authors.forename: Filip J
authors.initials: FJ
authors.lastname: Couturier
authors.affiliation: Department of Gastroenterology and Hepatology, Sint-Vincentius Hospital, Sint-Vincentiusstraat 20, 2018 Antwerpen, Belgium.
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Colemont
authors.affiliation: Department of Gastroenterology and Hepatology, Sint-Vincentius Hospital, Sint-Vincentiusstraat 20, 2018 Antwerpen, Belgium.
authors.forename: Herbert
authors.initials: H
authors.lastname: Fierens
authors.affiliation: Academic Center for Primary and Interdisciplinary care, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium. Electronic address: veronique.verhoeven@uantwerpen.be.
authors.forename: Veronique M
authors.initials: VM
authors.lastname: Verhoeven
mesh_terms: D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D019587:Dietary Supplements / Q000009:adverse effects*; D006801:Humans; D008111:Liver Function Tests; D008297:Male