title: Hepatotoxicity due to red bush tea consumption: a case report.
abstract: Many conventional drugs used today, including isoniazid, dapsone, and acetaminophen, are well recognized culprits of hepatotoxicity. With increasing use of complementary and alternative medical therapies, several herbal medicines, such as Ma-Huang, kava, and chaparral leaf, have been implicated as hepatotoxins. Hepatotoxicity may be the most frequent adverse reaction to these herbal remedies when taken in excessive quantities. A myriad of liver dysfunctions may occur including transient liver enzyme abnormalities due to acute and chronic hepatitis. These herbal products are often overlooked as the causal etiologic agent during the evaluation of a patient with elevated liver function tests. We describe a case of hepatotoxicity due to ingestion of red bush tea diagnosed during preoperative assessment of a patient scheduled for laparoscopic appendectomy. Elevated liver enzymes and thrombocytopenia detected in the patient's laboratory work up confounded the initial diagnosis of acute appendicitis and additional investigations were required to rule out cholecystitis and other causes of hepatitis. Open appendectomy was done uneventfully under spinal anesthesia without any further deterioration of hepatic function.
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: shreddy@montefiore.org.
authors.forename: Shamantha
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: pragyan79@gmail.com.
authors.forename: Pragnyadipta
authors.initials: P
authors.lastname: Mishra
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: sana.qureshi@med.einstein.yu.edu.
authors.forename: Sana
authors.initials: S
authors.lastname: Qureshi
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: sinair@montefiore.org.
authors.forename: Singh
authors.initials: S
authors.lastname: Nair
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: tstraker@montefiore.org.
authors.forename: Tracey
authors.initials: T
authors.lastname: Straker
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery; D036903:Aspalathus / Q000737:chemistry*; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D008111:Liver Function Tests; D008297:Male; D000069459:Teas, Herbal / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced*; D000637:Transaminases / Q000097:blood*
chemical_list: D000069459:Teas, Herbal; D000637:Transaminases
keywords: Hepatotoxicity; Herbal tea; Red bush tea; Rooibos; Spinal anesthesia