# Acute Liver Injury Following Herbal Drink Consumption With Steatosis and Immune Activation: A Case Report

## TL;DR

A 32-year-old man developed acute liver injury after consuming a herbal drink, showing elevated liver enzymes and immune activation.

## Contribution

This case report highlights the liver toxicity risk of polyherbal remedies and emphasizes early detection for preventing complications.

## Key findings

- The patient showed severe liver damage with AST 1,043 U/L and ALT 1,645 U/L after herbal drink consumption.
- Elevated IgG levels indicated immune activation as a possible mechanism for the liver injury.
- The patient improved with supportive care, but the case underscores the risks of herbal remedies.

## Abstract

Herbal medicines are widely used for their perceived health benefits; however, their potential for liver toxicity is well-documented. We report a case of acute liver injury (ALI) in a 32-year-old male patient following the consumption of a multi-herbal drink. The patient, with a history of cholecystectomy for gallstones and nephrolithiasis, presented with severe epigastric pain radiating to the right shoulder, nausea, high blood pressure (170/113 mmHg), and a rapid heart rate. Laboratory tests revealed significant liver damage, with aspartate aminotransferase (AST) at 1,043 U/L, alanine aminotransferase (ALT) at 1,645 U/L, and total bilirubin at 4.8 mg/dL. Ultrasound imaging showed fatty liver disease without bile duct obstruction. Autoimmune testing was negative for antinuclear antibodies (ANA) and antimitochondrial antibodies (AMA), while elevated immunoglobulin G (IgG) levels suggested immune activation as a potential mechanism. The patient improved with supportive care. This case highlights the potential liver toxicity of polyherbal remedies and underscores the importance of early recognition and management to prevent long-term complications.