# Complementary and Alternative Medicine-Induced Combined Hepatorenal Toxicity: A Case Report

## TL;DR

A man developed severe liver and kidney damage after using unregulated herbal supplements to treat fatty liver, highlighting the risks of complementary and alternative medicine.

## Contribution

This case report presents a rare instance of combined hepatorenal toxicity caused by specific herbal CAM products.

## Key findings

- The patient's liver and kidney dysfunction was likely caused by CAM containing Carica papaya, Alstonia boonei, and Tetrapleura tetraptera.
- Discontinuation of the supplements and supportive care led to improvement in symptoms and biochemical markers.
- The RUCAM score indicated a probable causal link between the CAM and hepatocellular DILI.

## Abstract

Drug-induced liver injury (DILI) is a leading cause of liver disease globally, with complementary and alternative medicine (CAM) representing a significant contributor due to its widespread use and limited regulation. CAM encompasses diverse practices and products, with regional and ethnic diversity, many of which are used to treat liver disease. Even though a few natural remedies have been utilized for centuries, most lack scientific evidence for their safety and efficacy. This report describes a 42-year-old male who self-treated his fatty liver with CAM, culminating in severe concomitant hepatic and renal dysfunctions. Comprehensive evaluation excluded viral, autoimmune, metabolic liver diseases, and obstructive biliary diseases. The Roussel Uclaf Causality Assessment Method (RUCAM) score indicated a probable causal link between CAM and DILI of hepatocellular pattern. The constituents of the CAM, extracts of Carica papaya, Alstonia boonei, and Tetrapleura tetraptera, have been implicated in hepatotoxicity in animal models. Discontinuing the supplements and supportive care, including N-acetyl cysteine, led to symptomatic and biochemical improvement. This case highlights the importance of clinicians' awareness of CAM-related DILI, emphasizing the need for vigilance and patient education about the potential risks associated with herbal products.