Hepatitis Induced by Noni Juice from Morinda citrifolia: A Rare Cause of Hepatotoxicity or the Tip of the Iceberg?Yüce B. · Gülberg V. · Diebold J. · Gerbes A.L.
aDepartment of Internal Medicine II and bInstitute of Pathology, Ludwig Maximilians University of Munich, Munich, Germany
A 24-year-old female patient presented to her community hospital with mild elevations of serum transaminase and bilirubin levels. Because of multiple sclerosis, she was treated with interferon beta-1a for 6 weeks. After exclusion of viral hepatitis due to hepatitis A–E, interferon beta-1a was withdrawn under the suspicion of drug-induced hepatitis. One week later, she was admitted again to her community hospital with severe icterus. The transaminase and bilirubin levels were highly elevated, and a beginning impairment of the liver synthesis was expressed by a reduced prothrombin time. The confinement to our department occurred with a fulminant hepatitis and the suspicion of beginning acute liver failure. There was no evidence for hepatitis due to potentially hepatotoxic viruses, alcoholic hepatitis, Budd-Chiari syndrome, hemochromatosis, and Wilson’s disease. In her serum there were high titers of liver-kidney microsomal type 1 autoantibody; the serum gamma globulin levels were in the normal range. Fine-needle aspiration biopsy of the liver ruled out an autoimmune hepatitis but showed signs of drug-induced toxicity. During the interview, she admitted that for ‘general immune system stimulation’ she had been drinking Noni juice, a Polynesian herbal remedy made from a tropical fruit (Morinda citrifolia), during the past 4 weeks. After cessation of the Noni juice ingestion, her transaminase levels normalized quickly and were in the normal range within 1 month.
Veit Gülberg, MD
Department of Internal Medicine II, Ludwig Maximilians University of Munich
DE–81377 München (Germany)
Tel. +49 89 7095 0, Fax +49 89 7095 5284, E-Mail firstname.lastname@example.org
Published online: July 11, 2006
Number of Print Pages : 4
Number of Figures : 2, Number of Tables : 1, Number of References : 9
Digestion (International Journal of Gastroenterology)
Vol. 73, No. 2-3, Year 2006 (Cover Date: July 2006)
Journal Editor: Beglinger, C. (Basel)
ISSN: 0012–2823 (print), 1421–9867 (Online)
For additional information: http://www.karger.com/DIG