Ip S, Jeong R, Schaeffer DF, Yoshida EM. Unusual case of drug-induced cholestasis due to glucosamine and chondroitin sulfate. World J Hepatol 2015; 7(24): 2559-2562 [PMID: 26527309 DOI: 10.4254/wjh.v7.i24.2559]
Corresponding Author of This Article
Dr. Eric M Yoshida, Professor of Medicine, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, 5th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada. eric.yoshida@vch.ca
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 28, 2015; 7(24): 2559-2562 Published online Oct 28, 2015. doi: 10.4254/wjh.v7.i24.2559
Unusual case of drug-induced cholestasis due to glucosamine and chondroitin sulfate
Stephen Ip, Rachel Jeong, David F Schaeffer, Eric M Yoshida
Stephen Ip, Eric M Yoshida, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
Rachel Jeong, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
David F Schaeffer, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
Author contributions: All authors contributed to the writing of this case report.
Institutional review board statement: The University of British Columbia Clinical Ethics Review Board does not require approval for case reports. Ethics approval is not necessary for this case report.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors have no financial support or conflicts of interest to report.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Eric M Yoshida, Professor of Medicine, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, 5th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada. eric.yoshida@vch.ca
Telephone: +1-604-8755371 Fax: +1-604-8755447
Received: June 4, 2015 Peer-review started: June 9, 2015 First decision: July 6, 2015 Revised: July 25, 2015 Accepted: September 16, 2015 Article in press: September 18, 2015 Published online: October 28, 2015
Abstract
Glucosamine (GS) and chondroitin sulfate (CS) are common over-the-counter (OTC) supplements used in the treatment of osteoarthritis. These medications are seemingly safe, but there are increasing reports of hepatotoxicity with these supplements. We reported a unique case of drug-induced cholestasis caused by GS and CS in a combination tablet. The etiology of the jaundice was overlooked despite extensive investigations over a three-month period. Unlike drug-induced hepatocellular injury, drug-induced cholestatic jaundice with GS and CS has only been reported twice before. This case emphasizes the importance of a complete medication history, especially OTC supplements, in the assessment of cholestasis.
Core tip: Glucosamine and chondroitin sulfate are common over-the-counter medications available in North America and other countries in the treatment of osteoarthritis. We report a unique case of drug-induced cholestatic injury caused by this combination tablet. The etiology of this patient’s new jaundice went undiagnosed despite extensive investigations over three months. Only after careful questioning of his medication history and review of his liver biopsy was the correct diagnosis obtained. This case adds to the increasing reports of hepatoxicity related to this supplement. Furthermore, it highlights the importance of a complete medication history, especially over-the-counter medications, in the assessment of cholestatic jaundice.
