Ulrich Seybold, MD; Nikola Landauer, MD; Susanne Hillebrand, MS; Frank-Detlef Goebel, MD
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Seybold U, Landauer N, Hillebrand S, Goebel F. Senna-Induced Hepatitis in a Poor Metabolizer. Ann Intern Med. 2004;141:650-651. doi: 10.7326/0003-4819-141-8-200410190-00024
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Published: Ann Intern Med. 2004;141(8):650-651.
TO THE EDITOR:
Background: Preparations of senna leaves and fruits are widely used to treat constipation. Most reports of toxicity have involved only large doses.
Objective: To show the increased potential for toxic effects of senna in the context of a variant of cytochrome P450 2D6 (CYP2D6).
Case Report: A 28-year-old woman presented with a 2-week history of fatigue, myalgias, epigastric pain, pyrosis, and nausea. For 2 days, she had noted yellowish eyes and dark urine. Recently, she had been consuming 3 to 4 L of beer per week. She had previously received hepatitis A virus and hepatitis B virus immunization, had no history of blood transfusions or jaundice, and did not report taking any medications. On physical examination, the only abnormalities were a scleral icterus and epigastric tenderness. An extensive panel of laboratory studies detected no abnormalities. The patient declined liver biopsy. Ultrasonography showed only increased hepatic echogenicity. The patient's living, working, and leisure environments had no apparent sources of toxin exposure.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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