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Table of Contents
Vol. 73, No. 2-3, 2006
Issue release date: July 2006
Digestion 2006;73:167–170
(DOI:10.1159/000094524)

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

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Abstract

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 After exclusion of viral hepatitis due to hepatitis A–E, interferon beta-1a was withdrawn under the suspicion of drug-induced hepatitis.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.



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References

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  2. Wang MY, West BJ, Jensen CJ, Nowicki D, Su C, Palu AK, Anderson G: Morinda citrifolia (Noni): a literature review and recent advances in Noni research. Acta Pharmacol Sin 2002;23:1127–1141.
  3. Alvarez F, Berg PA, Bianchi FB, et al: International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999;31:929–938.
  4. Pageaux GP, Larrey D: Alternative medicine, vitamins, and natural hepatotoxins; in Kaplowitz N, DeLeve LD (eds): Drug-Induced Liver Disease. New York, Marcel Dekker, 2003, pp 709–724.
  5. Stadlbauer V, Fickert P, Lackner C, Schmerlaib J, Krisper P, Trauner M, Stauber RE: Hepatotoxicity of Noni juice: report of two cases. World J Gastroenterol 2005;11:4758–4760.
  6. Millonig G, Stadlmann S, Vogel W: Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation (Morinda citrifolia). Eur J Gastroenterol Hepatol 2005;17:444–447.

    External Resources

  7. Hinrichsen H, Lüttges J, Klöppel G, Fölsch UR, Schmidt WE: Idiosyncratic drug allergic phenprocoumon-induced hepatitis with subacute liver failure initially misdiagnosed as autoimmune hepatitis. Scand J Gastroenterol. 2001;36:780–783.
  8. Stedman C: Herbal hepatotoxicity. Semin Liver Dis 2002;22:195–206.
  9. Tremlett HL, Oger J: Elevated aminotransferases during treatment with interferon-beta for multiple sclerosis: actions and outcomes. Mult Scler 2004;10:298–301.


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