We report the case of a 56-year-old woman with no history of liver disease, regular consumer of Herbalife products and Noni juice.
She came to the emergency department with nonspecific abdominal pain, nausea and mucocutaneous jaundice.
Physical examination showed no neurological deterioration.
Blood tests revealed: ALT 940 U/l, AST 1300 U/l, GGT 173U/l, FA 187 U/l, LDH 431 U/l, total bilirubin 21,45 mg/dl.
The study of the etiology included serology of hepatotropic virus: HAV, HBV, HCV, HEV, CMV, EB, VZV, HHV 6-8 which were IgG and IgM negative.
HIV serology was negative.
HCV-RNA and HBV-DNA negative.
The serology of Coxiella, T. Cruzi, Treponema and Brucella were negative for IgG and IgM.
Wilson's disease, alpha-1 antitrypsin deficiency and autoimmune hepatitis were also ruled out.
Abdominal ultrasound and magnetic resonance cholangiography ruled out biliopancreatic pathology.
The analytical evolution was torpid as shown in Table I. In transjugular liver biopsy, lobular hepatitis with confluent necrosis was observed, which started nodular transformation.
In the third week of evolution, the patient developed an episode of grade II hepatic encephalopathy and clinical worsening with ascites.
The clinical picture progressed to liver failure requiring urgent liver transplantation, with good outcome later.
