Toxic hepatitis due to a food supplement: "Natural" is no synonym for "harmless"

Background/aims: Herbal products are increasingly used in modern medicine for numerous indications. They are not considered as drugs and thus often not linked to side effects. Material: A 77-year-old patient presented with silent icterus and biochemical evidence of hepatocellular damage. Because of dyslipidaemia, he was recently prescribed Controchol (R), a food supplement containing red yeast and green tea extracts. Results: Liver biopsy showed necro-inflammatory destruction of liver parenchym, collapse of reticulin matrix, cholestasis and gall duct damage, compatible with toxic hepatitis. After discontinuation of Controchol (R), there was a gradual normalisation of the liver function tests. Liver injury is a known side effect of both red yeast and green tea extracts. After exclusion of other causes, we therefore concluded our patient had suffered from Controchol (R)-induced toxic hepatitis. Conclusion: Products that are conceived as "natural" alternatives for pharmacological drugs, like food supplements, are not free of side effects per se, and should not be considered as "harmless". (C) 2016 Elsevier Masson SAS. All rights reserved.