Fulminant Liver Failure Due to Usnic Acid for Weight Loss

The use of complementary and alternative medicine (CAM) in developed countries has increased significantly over the years. Among the most popular are the weight loss supplements or “fat burners.” Liver failure due to these popular remedies has been widely recognized. Usnic acid has been an ingredient of dietary supplements that cause liver failure. Its hepatotoxicity has not been recognized because it is usually mixed with other ingredients that are presumably hepatotoxic. We describe a case of a 28-yr-old woman who presented with fulminant liver failure requiring orthotopic liver transplantation, after taking pure usnic acid for weight loss. This is the first report on fulminant liver failure associated with the ingestion of pure usnic acid. A discussion about hepatotoxicity of the different compounds of dietary supplements is presented. This is a reminder for the clinicians about the potential side effects of CAM.

[1]  William M. Lee,et al.  Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States , 2002, Annals of Internal Medicine.

[2]  Sean S. Park,et al.  Severe Hepatotoxicity Associated with the Dietary Supplement LipoKinetix , 2002, Annals of Internal Medicine.

[3]  R. Carithers,et al.  Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. , 2002, Journal of hepatology.

[4]  T. Kaptchuk,et al.  Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey , 2001, Annals of Internal Medicine.

[5]  E. Walters,et al.  Long-Term Trends in the Use of Complementary and Alternative Medical Therapies in the United States , 2001, Annals of Internal Medicine.

[6]  G. Serino,et al.  Antimitotic effects of usnic acid on different biological systems , 1997, Cellular and Molecular Life Sciences CMLS.

[7]  J. Marshall,et al.  Acute hepatitis associated with the use of a Chinese herbal product, ma-huang. , 1996, The American journal of gastroenterology.

[8]  A. N. Abo-khatwa,et al.  Lichen acids as uncouplers of oxidative phosphorylation of mouse-liver mitochondria. , 1996, Natural toxins.

[9]  N. Yanofsky,et al.  Kombucha "mushroom" hepatotoxicity. , 1995, Annals of emergency medicine.

[10]  M. Tainter,et al.  USE OF DINITROPHENOL IN OBESITY AND RELATED CONDITIONS: A PROGRESS REPORT , 1933 .

[11]  D. Schuppan,et al.  Herbal hepatotoxicity. , 2005, Journal of hepatology.

[12]  N. Kaplowitz.  Biochemical and Cellular Mechanisms of Toxic Liver Injury , 2002, Seminars in liver disease.

[13]  M. Borum.  Fulminant exacerbation of autoimmune hepatitis after the use of ma huang , 2001, American Journal of Gastroenterology.