Case Report
Toxic Hepatitis Induced by Gymnema sylvestre, a Natural Remedy for Type 2 Diabetes Mellitus

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Abstract

Toxic hepatitis or drug-induced liver injury (DILI) encompasses a spectrum of conditions ranging from mild biochemical abnormalities to acute liver failure. Recent studies report that 35% to 48% of patients with diabetes use some form of complementary and alternative medical therapy. Moreover, >800 plants have been traditionally used for the treatment of diabetes. Despite this widespread use, only few were supported by rigorous clinical evidence. Gymnema sylvestre, also known as gurmar (sugar destroyer in Hindi), is a plant considered to be with potent antidiabetic effects and, hence, widely used in folk, ayurvedic and homeopathic systems in medicine. The authors were unable to find previous reports associating G sylvestre to liver injury. Herein, the authors report a case of DILI in a patient who was treated with G sylvestre for diabetes mellitus and review the literature to suggest possible mechanisms that led to this acute condition.

Section snippets

CASE REPORTS

A 60-year-old female florist was admitted with complaints of weakness, fatigue, jaundice, loss of appetite and weight loss. Her personal history revealed glaucoma treated with acetazolamide for the past 2 years and diabetes mellitus type 2 treated with life style modification until 17 days before admission, when she started taking an over-the-counter G sylvestre remedy in the form of tea, consumed 3 times a day. The patient stated that her symptoms had begun on the seventh day of G sylvestre

DISCUSSION

We report a case of hepatotoxicity caused by a “natural” over-the-counter remedy for diabetes mellitus. All the factors suspected to be responsible for hepatitis and disturbed liver function tests, such as viral agents, autoimmune disease, cholelithiasis, storage diseases such as Wilson disease, hemochromatosis and endocrine diseases such as hypo- and hyperthyroidism were excluded by the patients’ history, physical examination, laboratory tests and liver biopsy. This and the typical temporal

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