Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2019; 11(11): 735-742
Published online Nov 27, 2019. doi: 10.4254/wjh.v11.i11.735
Hepatotoxicity associated with Garcinia cambogia: A case report
Muhammad Nadeem Yousaf, Fizah S Chaudhary, Seyed Mohammad Hodanazari, Charmian D Sittambalam
Muhammad Nadeem Yousaf, Seyed Mohammad Hodanazari, Charmian D Sittambalam, Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD 21218, United States
Muhammad Nadeem Yousaf, Seyed Mohammad Hodanazari, Charmian D Sittambalam, Department of Medicine, MedStar Good Samaritan Hospital, Baltimore, MD 21239, United States
Muhammad Nadeem Yousaf, Charmian D Sittambalam, Department of Medicine, Medstar Franklin Square Medical Center, Baltimore, MD 21137, United States
Fizah S Chaudhary, Department of Internal Medicine, American University of Barbados, Wildey 11100, Barbados
Author contributions: Yousaf MN contributed to manuscript writing and overall data collection; Chaudhary FS and Hodanazari SM contributed to review of manuscript and data and proof reading; Sittambalam CD contributed to manuscript supervision.
Informed consent statement: Informed consent statement was signed by the patient.
Conflict-of-interest statement: The authors have no conflict of interest.
CARE Checklist (2016) statement: The authors have prepared the manuscript according to CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Muhammad Nadeem Yousaf, MD, Doctor, Department of Medicine, Medstar Franklin Square Medical Center, Second Floor, Primary Care Center, 9000 Franklin Square Drive, Baltimore, MD 21137, United States.
Telephone: +1-443-7778300 Fax: +1-443-7777869
Received: August 22, 2019
Peer-review started: August 22, 2019
First decision: September 20, 2019
Revised: September 28, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 27, 2019

Herbal supplements (HS) for weight loss are perceived to be “safe” and “natural”, as advertised in ads, however, hepatotoxicity can be associated with consumption of some HS. Use of HS may be missed, as the patient may not report these unless specifically asked about these products, since they are often not thought of as medications with potential side effects or interaction potential.


We reported a case of a 21-year-old female with morbid obesity who presented with abdominal pain for 1 wk associated with nausea, vomiting, anorexia and myalgias. She denied smoking tobacco, drinking alcohol, usage of illicit drugs, hormonal contraceptives, or energy drinks. There was no significant past medical or family illnesses. Her laboratory workup revealed acute liver failure. The workup for possible etiologies of acute liver failure was unremarkable. She was using a weight loss herbal supplement “Garcinia cambogia” for 4 wks. This case demonstrates the association of acute liver failure with Garcinia cambogia.


Medical reconciliation of HS should be performed in patients with suspected acute liver failure and early discontinuation of HS can prevent further progression of drug induced hepatoxicity.

Keywords: Hepatotoxicity, Drug induced liver injury, Acute liver failure, Herbal supplements, Garcinia cambogia, Obesity, Case report

Core tip: Drug induced liver injury is a diagnosis of exclusion of possible etiologies of liver failure. Medical reconciliation of herbal supplements is important in these patients. The Council of International Organizations of Medical Sciences and Roussel Uclaf Causality Assessment Method “CIOMS/RUCAM” scale is a useful tool for the assessment of drug induced liver injury. A high index of suspicion is required for identification of patients with drug induced liver failure. Early discontinuation of offending agent may prevent progression of disease and results in rapid recovery.