Case Report
Copyright ©The Author(s) 2019.
World J Hepatol. Nov 27, 2019; 11(11): 735-742
Published online Nov 27, 2019. doi: 10.4254/wjh.v11.i11.735
Table 1 Laboratory testing done to investigate acute liver failure etiology
Laboratory testReference rangeResults
Liver function tests
Alanine aminotransferase15-41 U/L981 (H)
Aspartate aminotransferase3-34 U/L1062 (H)
Alkaline phosphate45-117 U/L248 (H)
Total bilirubin0.2-1.3 mg/dL1.3 (N)
Conjugated bilirubin0.0-0.30 mg/dL0.73 (H)
Total Protein6.3-8.2 g/dL6.8 (N)
Albumin3.5-5.0 g/dL2.8 (L)
Ammonia level0-32 μmol/L44 (H)
Coagulation Studies
Prothrombin time10-13.5 s19.0 (H)
International normalized ration0.8-1.21.6 (H)
Viral serologies
Hepatitis A, IgMNonreactiveNonreactive
Hepatitis A, IgGNonreactiveReactive
Hepatitis B, core IgMNonreactiveNonreactive
Hepatitis B, surface antigenNonreactiveNonreactive
Hepatitis C antibodyNonreactiveNonreactive
Human immunodeficiency virus 1 and 2 antibody/antigenNonreactiveNonreactive
Herpes simplex virus 1 and 2 IgMNegativeNegative
Cytomegalovirus, IgMNegativeNegative
Cytomegalovirus, IgGNegativeNegative
Epstein Barr virus, IgMNegativeNegative
Parvovirus B19, IgM/IgGNegativeNegative
Rapid plasma regain (RPR)NonreactiveNonreactive
Influenza A, antigenNegativeNegative
Influenza B, antigenNegativePositive
Autoimmune liver disease panel
Antinuclear antibodyNegativeNegative
Antinuclear antibody titer< 1.0 U0.6 (N)
Antismooth muscle antibodyNegativeNegative
Antimitochondrial antibody, M2< 0.1 U< 0.1 (N)
Toxicology studies
Acetaminophen level10-30 mcg/ml< 2
Ethanol level0-3 mg/dL< 3
Urine toxicology screenNegativeNegative
Table 2 Case reports of hepatotoxicity related to non-Hydroxycut formulation of Garcinia cambogia since 2009
Case reportYearAgeSexDuration of GC useClinical presentationCIOSM/RUCAM scoreLiver transplantation
Present case201926Female28 dNausea, vomiting, abdominal pain, anorexia and myalgia9No
Sharma et al[15]201857Female28 dVomiting and abdominal pain11No
Kothadia et al[14]201836Female28 dFever, nausea, vomiting, abdominal pain, fatigue and jaundice8No
Lunsford et al[7]201634Male150 dNausea, vomiting, abdominal pain and dark urineNAYes
Smith et al[13]201626Male7 dFatigue, icteric sclera and skin6Yes
Corey et al[12]201652Female25 dFatigue, intermittent confusion and jaundice7Yes
Melendez-Rosado et al[11]201542Female7 dNausea, abdominal pain, clamminessNANo
Lee et al[16]201439Female2 dNausea, abdominal pain, anorexia, dyspepsia, fatigue and jaundice9No
Sharma et al[10]201019MaleNAFever, fatigue, myalgia, arthralgia, Nausea, Vomiting, abdominal pain and jaundice, erythematous skin rash lower extremities7No
Table 3 The Council of International Organizations of Medical Sciences and Roussel Uclaf Causality Assessment Method Scale
Time from drug intake until reaction onset
5-90 d+2
< 5 or > 90 d+1
Time from drug withdrawal until reaction onset
< 15 d+1
> 15 d0
Alcohol risk
> 55 yr+1
< 55 yr0
Course of reaction
> 50% improvement within 8 d+3
> 50% improvement within 30 d+2
Worsening or < 50% improvement in 30 d-1
Concomitant therapy
Time to onset incompatible0
Time to onset compatible but with unknown reaction-1
Time to onset compatible but known reaction Role proved in the case-2 -3
None or information not available0
Exclusion of non-drug related causes
Ruled out+2
Possible or not investigated0
Previous information on hepatotoxicity
Reaction unknown0
Reaction published but unlabeled+1
Reaction labeled in the product’s characteristics+2
Response to re-administration
Not available or not interpretable0
Plasma concentration of drug known as toxic+3
Validated laboratory test with high specificity, sensitivity, and predictive values positive+3
Validated laboratory test with high specificity, sensitivity, and predictive values negative-3
Interpretation of score for drug induced liver injury:
> 8 definite drug induced liver injury
6-8 probable drug induced liver injury
3-5 Possible drug induced liver injury
1-2 Unlikely drug induced liver injury
< 0 drug induced liver injury excluded